HomeMy Public PortalAbout6160 OAK AVE_Sewer__ 76808 10-62
A64R 2D APPLICATION FOPERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BurLDIN
ADDRESS
JOHN A. LAMBIE Courity Engineer
WILLIAM A. JENSE�.� Sup't of uilding L-OCA6.17Y
FOR APPLICANT,ZO-FILL IN CROSS ST.
LEGAL -
DESCRIPTION L OWNER
M Ali I L
BLOCK TRACY ADDRESS
NO. OF FILDGG
Sin- OF LOT NOW ON 1,01' CITY TEL. NO.
USE OF
DISTRICT NO.1 GROUP MAP PROCESSED BY
BK PG
Ce;'TRACTOR
ADORECONNECTION DATA
STATION DEPTH
C, TEL, NO.
REGISTRAIION NO
SAE MANHOLE REFERENCE T .
Pi C TOUNTY
NO, 1 DESCRIPTION OF WORK FEE, rypF-OF CONN5-QTiON LENCTH FRCIM
Y. M. TO P.L.7
HOUSE SEWER CONNECTING CURB P.L� L 0
pL
PUR'lic SEWER
- - @ _$ -j
SEPTIC TANK,SEEPAGE P!T OR ---- P.0NO.
PITS ANO/OR DRAINFIFLD @ *10:00 CD.J MP�_NO JOB NO.
HC US Z:SEWER CONNECT:NG TO TRUNK PERMIT No. ROAD PERMIT N C12
PRIVAIE DI-1POSAL SYSTEM Q 53.00
CONN=ADOITfONAI.BLDG.OR -FN5MR.NO. DATE
WORK TO HOUSE SEWER @ s3.00
i EXTN.,CESL,
DRY HOLE@ n.00 z
HWY.OR ST.WIDENING
I ALTER.R[PAttt OR ABANDON Ii Ol.LSE.
SEWER OR DISPOSAL SY37�m @ STATFENCROACHMENT
-
PERMITNO.
IN DUSTRIZ
WASTE APPROVAL
C
OWNE117S------j PER-MIT $ 11 A R.G 1-5
CONNECTION'CHARGE FEE
AUTHORIZATION I TOTAL FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
REIMBURSEMENT rEE
TRACTORTo CONNECI THE ABOVE DESCRIBEC rXISTING DWrL;-iNLG
TO THE-:, .V81-iC SEWER. APPROVALS DATE 1 INSPECTOR SIGNATURE
SIGNED THISDAYOF-------- _19 ------- ----------- -- I- ------ ,— -.--
OWNIER OR NEW HOUSE SEWER
OWNERS AGENT—
C 0 N N FC T ADD I T 10 14 AL
ADDRESS BUILDING 7R.WORK
4
SEPTIC TANK,SLEP,F!T 1 1)
I HEREBY ACKNOWLEDGE THA- ! HAVE READ TH!S APPL.FCA7)ON AND/OR DRAINFIELD
.AND
N D ST.4'rF THAT THE ABOVE tS CORRECT AND AGREE TO COMPLY
WJTY§
ALA, COUNTY ORDINAS NCEAND STATE LAWS -REGULAIING CESSPOOL. F-j DRYWFLL
likiSiNG AND SEWERS,
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.,SEWER OR
LICENSED AS REQUIRED EY LOS ANGLF-'� COUNT' AND STATE OF SEWAGE DISPOSAL SYSTEM
G 'T
RESIDE IN,
OR THAT rl AM THE BLE ArSCWNER OF, AND NTEND 'TO CISCO NNIEC PLUG AN
THF - E T!A L - e
ES OF IN, ABOVE D4FSCRl ED R iDEN PROPERT' ABANDON HOUSE SEWED
SIGNATURE
O'S' PERMITTEE SEE BAC..-_.._- SEPTIC TANKS
E
P,PTT(Si
L❑-1 C S5POOL5 [-j
,�.-VtALIDATION ROBERT A. WOOD
M.0, CASH SUPEIRVISiNG MECHANICAL ENGINEER
LG'I,-
—X�