HomeMy Public PortalAbout6325 OAK AVE_Sewer__ J
;& 6311.58 APPLICATION FOA R-MIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS �
CASSATT D,GRIFFIN, SUPT.1 1IjILD1N.
LOCALITY
NEAREST
_ FOR APPLICANT TO FILL IN CROSS ST. ='
DESCRIPTION LOT NO OWNER ✓ 5 �A4
BLOCK TRACT : l' �-y., . ate. "RALE °
ADDkE55
NO. OF BLDGS. �
SIZE OF LOT _ NOV1 ON LOTS CITY . ,r TEL. N0.
USE OF
BUILDINGS y v - '' f ,,�' ❑ISYRFCT O. �.`GROUP i MAP
CONTRACTURE`; I � -
r v, ` CONNECTION DATA
ADDRESS --
,- STATION,. �` DEPTH
CITY 'TEL.NO.
MANHOLE REFERENCE PP_ER
-
�' [Q-.'STATE
REGISTRATION NO. ' F' [] COUNTY
No. DESCRIPTION OI WORK FEE - - - ---
TYPE OF ION LENGTHFROM
HOUSE SEWER CONNEC7INGTp Y. CURB P.L. M.L. TO P.L, -`
PUBLIC SEWER - - - --- $_3.50 __•+ �r•�. 's -- - ----._
t
SEPTIC TANK,SEEPAGE PIT OR ; 'y
-J PITS AND OR DRAINFIELD __ Ca $3.0.0
! OVERFLOW SEEPAGE PIT,DRAINFIELDt P. C. NO..
EXTN-CESSPOOL_DRYWFLL.MA.NHOLE IOL_$2.00 j I CO. IMP. NO.� � 41 JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE.DISPOSAL SYSTEM (epi $1;00 j j TRUNK PERMIT NO. ROAD PERMIT NO.
j� CONNECT ADDITIONAL BLDG OR I 1 STATE ENCROACHMENT -
_
WORK TO HOUSE SEWER _ L i.0il _ r'� _ _PERMIT NO.
I ALTER,R[PAIR OR ABANDON HOUSE. -yY�- INDUSTRIAL - -'
� SEWER OR DISPOSAL SYSTEM C�' _
- -------- ---,--_-- =.�t.Ot,; _---�-_------ WASTE APPROVAL
I �
---�------------ --------_-----�----- --- _
CHARGES
I_- CONNECTION CHARGE FEE
OWNER'S PERMIT -i - ----------------------...
- i - REIMBURSEMENT FEE
AUTHORIZATION - TOTAL FEE � r
DATE A CONTRACT WITH THE REIN NAM D CON- APPROVALS U��.TE INSPE .TUR'S SIGNATURE
t HAVE A7 THIS T` `' ----- --r - I NSPE---------- ------_.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELL]
TO THE PUBLIC SEVqR,_ NEW HOUSE SEWER
SIGNED THIS —DAY
_y,F� CONNECT T ADDITIONAL
OWNER OR .., �' ! �. EUILD NG OR WORK - -- 1 .-- --
OWNERS AGE_NT _ ._—. ----- -- - -
- AN
C SEPT i -K
T SEEP. PST(S)
'1D GRES _� "``•. +� ? ss.1{�Y�s "3.Ndr AND/OR DRAINFIELD
— r3 _
I HEREBY ACKNOWLE CE THAT,1 HAVE READ TH'.S APPLICATION- CESSPOOL J DRYW�ELL❑
AND STATE THAT THE ABO/.; IS 'CCitRECT ANA AGREE TO COMPLY" .----— -.-. -------
W
:"i IIF ALI. COUNTY ORDINAN,CTS AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR I Ji
PLUMBING AND SEWERS, - SEWAGE DISPOSAL SYSTEM
1 HERE.DY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REPUIRE➢ BY LOS ANGELES 'wOUNTY AND STATE OF
CALIFORNIA -0 R. AT If h1^, 'THE LEGAL OWNER,�'Lj.A TH,E,ABOVE' f BANDI.N HOUSE SE�dER -------
D BjEJ3-�tES ERiY./
',/ ,f FACK ILL SEPTIC TANKS
❑ ( I _
Sl�� j��RR£ / 7i'`''. + yC.' yF�l�•' r;`. "'*[g,�'. �Et:P_ N iS.l i0 CESSPOOLS��;j ---
'Y <RAt(T7 E - - -- ---- --�
1OHN A. LAMBIE, COUNTY SNG[NEER VALIDATION ROBERT A. WOOD,CHIEF PLF3G. INSPECTOR
CK. M. 0.