HomeMy Public PortalAbout6227 OAK AVE_Sewer__ 76AG4210
F-663 11-55 APPLICATION FOR PERMIT
DI'VISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Depaxtment of County Engineer
County of Los Angeles BUILDING r
JOHN A. LAMBIE, COUNTY ENGINEER
RD CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,
LEGAL
RIPTiON LOT NO,, _y J OWNER
F'-ESCLOCK TRACT f
MAIL
_ADDRESS
LT. Z di, TEL. NO..
_SIZE OF L07
HO. OF
CITY
USE OF c7
-BUILDINGS DISTRICT,NO. i GROUP BK MAP PG
CONTRACTOR
COMiECTION DATA ADDRESS
STATION a ' DEPTH
CITY TEL. N
��—*——tt
MANHOLE REFERENCE
-ff-STATE . LOWER
REGISTRATION NO. COUNTY
DESCRIPTION OF WORK FEE
TYPE OF CONNECTION,. LENGTH FROM
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3."o CURB P.L. M.L, TO P.L.
SEPI IC TANK E-PTT--Q-R--
PIT$AND!OR DRAINFIELD (CC, $3,00
IT--,-D-R-A I-N-F HELD P. C. NO
1 N_CESSPOOLL-I,DNRYEN ELL.MA
N HOLE (a $2.00CO. IMP.
'e� .,/ -Z
HOUSE SEWER CICTING TO , -
PRIVATE DISPOSAL SYSTEM (cgs 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
..........
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
1 WORK TO HOUSE SEWER (,-J, $1,00 PERMIT NO.
--l-
ALTER,-REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM b i.00
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
J HAVE AT THIS DATE A CONTRACT ',VlrH THE HEREIN NAMED CON- APPROVALS DATE IN SPECTOR'.5 5 1 G NA(URE
TRACTOR TO CONNEC'C THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER,
NEW HOUSE SEWER
r
SIGNED THIS CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGE SEPTIC TANK,SEEP,PIT(S)
ADDRESS-.-- N F1 ELI)
HW
------- ----
1 RFBY ACKNOLEDGE THAT I HAVE READ THIS APPLICATION
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Cj DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER.OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
HERE81Y CERTIFY THAT I AM PROPERLY REGISTERED ANWOR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON PLUG
DESCRIBED RESIDENTI L-,PROPERTY, BACKFILL SEPTIC TANKS E!
SIGNATURE SEEP. PIT IS:I Ll CESSPOOLS[I
QFPERMITT
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PL8G. INSPECTOR
CK. 14,0. CkSH
2 3 4 M F-a 13 4 A 4.5 -0
7- Co