HomeMy Public PortalAbout6158 OAK AVE_Sewer__ .E608 2.70 APPLICATION FOR PERMIT
'SA 64ZD
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRESS
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JOHN A. LAMBIE, COUNTY ENGINEER -COLEMAN W. JENKINS, SUPT. OF BUILDINGALITY.FOR APPLICANT TO FILL IN55 ST. ,,,.
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:E808 10-63
6A642D APPLICATION FOR. PERMIT
COUNTY OF LOS ANGELES
DtPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION B LLWNG
FOHN A. LHMBIE. County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building µ — - — --- ---
LC4CALiTY
NEAREST J
FOR APPLICANT--.TO FILL: IN Pass 5T
LEGA( '
DESCRIK 'ION I_OT NO � .+" OWNER
M A i L - ..
BLOCK: TRACT - - .ADDRESS
-_ - NO. QF' LLOGS.` _
SIZE OF LOT P304V ON LOT CITY TEL. NO.
USE OF
BU1LD;NG5f r DISTRICT'NO. GROUP MAP PROCESSED BY
BK PC
CONTRACTOR
ADDRESS CONNECTION" DATA
CTEL. NO. 9 - - _-- STATION L. DEPTH
STATE y -
MANHOLE REFERENCE
REG IST RA tIOP�d NO. r .S' '- J � Cfl'u'NTY �
. -
NO. DESCRIPTION OF WORK FEE --- TYPE.OF CONNECTION � � LENGTH FROM -
_1- R CONNECTING
ON ,
HOUSE SEWER CONN EC:TI N(i TO �- - Y. ' CURB ;i P.L. M.L.to Y.L.
Pt,BLlC SEWERS 5-O Er_ - — '— -
—. —'—
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P.C.N.O. $
S EP71'C TG NK.SEEPAGE P]7 OR t CO.IMP NO. Y ^ JOB NO. $
PITS ANC OR C-P,AENFIF_LD @ $90.00 --_I
I,
HOUSE Sk.WLR CONNE 7!Y@G TO __— - - --i T---- TRUNK PERMIT NO. ROAD PERMITNO: �
PRIVA TE D POSAL SYSTEsA
r ONNECT ADOITIONAL BLDG.OR -- - AFFIDAV)T� 'A sivEa—EASEMENT l RECORD INSTR NO. j DATE jm
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT,DRAINI,IELO
£X1 N.,CE"SPOOL,DRYWELL,MANH.OLF°O' $5.00 b�°s
HWY.OR ST.WIDENING
ALTER,REPAIR OR ABANDON HOUSE .y
—.__.
.,
1 E`N Eti OR DISPfi3AL SYSTEM _.. -$3.00 STATE ENCROACHMENT
PERMIT NO.
iNDUSTRIAL
WASTE APPROVAL
____—._._--.—_ --_.._. -__ 7—___ CHARGES
O WNER'S PERMIT S z' otl _ ------ -----.. --- - --- ----- - -
___.__. -__—L CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE -----------
R8 - _.._--- - -- -------- --
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- --F MU RSEME NT FEE
TRACTOR TO CONNECT THE AE30VE DESCRIBED EXISTING DWELLING ------ yqy—/--- -- ---- ---, -- - '— --'--
TO THE PUBLIC SEWER. APPROVALS AL S DATE: j INSPECTOR'S SIGNATURE
SIGNED THIS,__-- ®A.Y OF'---
OWNER 0,14
F' __OWNEROR NEW HOUSE SEWER .� ..
OWNERS AGENT_-_._ CONNECT ADDiTiONAL i
---.- BUILDING OR WORK j
ADDRESS
SEPTIC TANK SEEP'
S'EHP PT
IT
i ti ERFBY Ar KNOWLEDGE THAI' I HAVF READ THIS APPLICATION ANI]/GiR PRAINFIE.LO
AND STAfE. 'T'HAT THE AgOVE 15 CORRECT AND AGREE TO COMPLY --- -- -.— — — - ---�� ---------------
WIT'li ALL COUNTY ORDINANCES AND STATE LAWS REGULATING, '
CESSPOOL ElDRYWELL ❑
PLUMBItJG AND SEW RS.
' HEREBY CERTIFY THAT . AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR j {
� 1
LICENSED AS. REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CA:.IFOR"NtA OR THAT A'f .4M THE LEGAL OWNER OF, AND INTEND TO -- _._,.._____—_. �
DiSCONtJECT PLUG AND j
::ES iDE IN, THC AL30VE- DESCRIBED RE-S,DENYIAL PROPERTY, ABANDON HOUSE SEWER
SIGNATURE b
OF PERMITTEE
BACKFILL SEPTIC ANKS. I�
___--- SEEP,PIT(S). ❑ CESSPOOLS ❑�
VALIDATION ROBERT A. WOOD
1 SUPERVISING MECHANICAL ENGINEER
O. CASH
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