HomeMy Public PortalAbout6229 OAK AVE_Sewer__ -BAsaz0 '
APPLICATIOi ' C3R PERMIT 1
i 8t E.,6B9 iI.SS
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Department of County Engineer
County of. Los Angeles BUILDING r
.JOHN A. LAMEiIE. COUNTY ENGINEER
ADDRESS ',�L ,sS,r �> + Sy
CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY
NEAREST
_FOR APPLICANT TO FILL IN _ CROSS ST. e
LEGAL _
DESCRIPTION LOT N0. OWNER
BLOCK. „Z- TRACTADDRESS �• � �-•' _ --rc
r, � i ' ray. /J -- _ r�r
NO.OF BLDGS.
CITY %1v. NO. + Ita' a >:
_SIZE OF LOT �_-- NOW ON LOT
TEL
. USE OF
BUILDINGS — - - DISTRICT N0. GROUPj BK MAP PG
CONTRACTOR
®:•r CONNECTION DATA
ADDRESS _ D <�`9 � q - 3__ „-:ray-y7 •' '. — _— ._._--.
..�; I'' 'S7ATION ��� , DEPTH - -
CITY r TEL. ND, --
`. �� ,,, � J MANHOLE REFERENCE � UPPER
STATE
REGISTRATION NOJ 0 ".ems- 7,j R-COUNTY --l------
NO. I --DESCRIPTION 0'F WORK FEE -- — ----
CHOOSE EWER CONNECTING CONNECTSNG TO '— ,,,: Y,- TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $_3,50CURB P.L. M.L. TO P.L. /-
- - -- --.I.--. _
SEPTIC TANK SEEPAGE PIT OR i
P1TS AND/OR DRAINFIEL D c $3.00
OV�'RF'LOW SEEPAGE F T, DPAINFIELD } P. C. NO. t
FXTN.•,CES° DOC.,DRYWELL,MAN_HOLEg'_ $2._00, I CO.CO_IMP_NO. ----JOB
JOB NO_
HOUSE SEVER CONNECTING TO —r —
j_PRIVATE DISPOSAL SYSTEM: cs 1.00 TRUNK PERMIT NO. ROADPERMITN,Q%' _
{ CONNECT ADDITIONAL BLDG.OR !Jam) — STATE ENCROACHM-ENT ''` ✓ "•'"�
—I WORK TO HOUSE SEWER_ /tt $7`00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM t - INDUSTRIAL
i.00 1OU j .-
----�-----------..—.—.--- --�------
WASTE APPROVAL
--`-----.__._.�—._.—..—..----------------- CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ _ t Do - ------ ------- ------
AUTH®RIZATI®N TOTAL FEE .+.rn REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS � DATE I INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER - -
I
SIGNED THIS DAY OF-----19--- CONNECT ADDITIONAL
OWNER OR `y"—` BUILDING OR WORK
OWNERS AGENT_ ,9 �--- .-_.. TANK,
,PIT($ I -
--------- - SEPTIC TANK,SEEP, PITtS)
ADDRESS.._ AND/OR DRAINFIELD -
i HE2EIY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONCES>POOLL} OPYWELLTI. i j
AND STATE TH,,T THE ABOVE iS CORRECT AND AGREE TO COMPLY ._.-._- .i--.-----------_—._._.__.__---
W;'IH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR i -
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
DISCONNECT P
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF LUG AND
CALIFORNIA OR THAT;-A AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTrkt PROPERTY" .p �- BACKFILL'SEPTIC TANKS(.1
SEEP, PIT(S) L_ CF"SSPOOL S L1
SIGNATURE i
_ -
OF PERMITT.
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLEG. INSPECTOR
CASH -
4 ��