HomeMy Public PortalAbout6152 OAK AVE_Sewer__ E808
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APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOA. LABIE, County Engineer ADD 5
HN M
WILLIAM A. JENSEN. Supt of AuxIding
LOCALITY
NTTA R E S T
FOR C APPLICANT TO IN ROSS 57.
SILL
LOT NO
OWNER
MA!L
BLOI.R ADDRESS
NO, OF SLOGS'
.ZE
OF LCT NOW ON LOT CITY TEL. NO.
USE OF
Su DISTRICT NO. G Up --S s v
R 0 MAP ocr D BY
BK
"N- PR
RACTOR
ADDRESS OJ . CNNECTION DATA
C ITY TEL. NO. STATION
DEPTH
RFG(STRATION NO STATE MANHOLE REFERENCE UPPER
COUNTY
NO DESCRIPTION OF WORKFEE TYPE OF CON.NQ_ LENGTH KA OM 0
Y. :'CURB '?N P.L. MA_TO P.L.HOUSE SEWER CONNECTING TOu
-
PUBLI( SEWER @ 5 00 P.C.NO.
rte_ r
SEPTIC TANk(,SEE-PAGE-PVT OR . . JOB NO.
PITS AND/QR DRAINFIELO @ $10�0 0 CO.IMPNO
------- 0
H 6 L)S�S E ViFR co w4 rc T 1 N�6_T_&
PRIVAT I-DISPOSAL SYSTEM (ND S3.00 PERMIT NO. ROAD PERMIT No..
-KD-6 1 T�j 6 N AL-6,LD6-6R7----
T
CONNEC AFFIDAVIT W DfF.R SASEMF T c R DAI
NOR:-
To HOUSE SEWER @ $3.00 V)
Z
OVERFLOW SEEPAGE PIT,DRA?NFIELD
EXTN..CESSPOOL,DRYWE:LL,MANHOL,E @ $5.00
—------ - HWY.OR ST.WIDENING
ALTER,REPAIR OR ABANDON HOUSE
SEWER - -6 ORWSPOSAL SY!�TEIVI_ -0o STATEF_NCROA N;
-Epmil'NO.
---------------- IND USIREAL,
WASTE APPR VAL
CHARGES
oMfMIR S
It00__
OEE
AUTHORIZATION TOTAL
HAVE AT THIS DATF A CONTRACT WITH THE HEREIN NAMED RIMSUR5EMENT FEE CON- _E
TRACT,DRT 0 CONNECT THE AE30VE DESCRIBED EXISTING DWELLING
To T, PUBLIC BLIC $EVlFR. APPROVALS i DATE i INSPECTOR'S SIGNATURE:
SIGNED THIS DAY
OWNEROR i 7 NEW HOUSE SEWER
OWNERS AGENT_,.___-�_�_,_
CONNECT ADDITIONAL
BLJ!fDiNG OR WORK
-SIFT;I
�I ANK.SEEP,PIT(5)
IHER68Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR ORAiNFiELO
AND
S"alrTHAT T HE ABOVE 15 CORRECT AND AGREE TO COMPLY -4—
WITH AI.L COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CE S5FO OI., L DRYWELL
HERESY CERTIFY THAT I E'AM PROPERLY REGISTERED AND/ R
OR ALTER.,REPAIR,SEWER OR
IC N SE 3 AS RE:QCIREr BY I OS ANGLES COUNTY AND STATOF SEWAGE DISPOSALSYS TE M
F ORINtA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
E)_IS'ONINJC,CT PLUG AND
_-
RESIDE iN, ',HE ABOVE. OrZSCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
5H.;NATURE
OF SACKFiLL SEPTIC .A N)(S
SEEP,plr(s) U CESSPOOLS
/---,-,.VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
K.,� W O, CASH