HomeMy Public PortalAbout6342 OAK AVE_Sewer__ "
EA'62
5A542D APPLICATION FOR PERMIT
42D
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 42 No . Oa_;{ --
COLEMAN W. JENKINS, SUPT. OF BUILDING
-
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. ]pyMar y
DESCR AL
LOT NO - OWNER U ohn 2�a s shall
y� +�
MAIL
BLOCK TRACT ) =Santa ADDRESS P.O.
��11 0(1 O/'� N0. OF SLOGS. '7 CITY sly eC'�•C�ia TEL. NO. 8
SIZE OF LOT„L2�„J]y'I O�,J'�t NOW ON T'L�,OT '1y __- (,J -9822
BUILDINGS Single ,1'C�,.mi ly Dwe l l in�_-_ DISTRICT NO. GROUPMAP PROCESSED BY
—---- —_-- HK PG
CONTRACTOR
"__tfohn Ma,L+CA]'hall_ CQn.s ru i"'3
ADDRESS26 N.Temple City B Z7d r� CONNE_CTION DATA �
STATION
CTY , it TEL. NO. -2�-90 pp DEPTH
STATE L!C 'p .MANHOLE REFERENCE �, UPPER
LICENSE NOE__ 6 SASS Bl LOW�L-R�.
NO. DESCRIF�O WORK FEE TYPE OF CONNECTt4N LENGTH FROM -
- -___-____-_ -- L. j...
HOUSE SEWER CONNECTING TO Y. CURB - P.L. , M.L.:70 P.L. �LL
>�q
PUBLIC SEWER $3.00 sem. ✓ .C,N�?_ !J
SEPTIC TANK SEEPAGE PIT OR CO.IMP.NO.
PITS AND/OR DRAINFIELD @ $10.00
I 1 _ —
HOUSE SEWER CONNECTING TO T flC
TRUNK PERMIT NO- ROAD PERMIT NO. O
�
CONNECT ADDITION AL BLDG.OR EASEMEN
�— AFFIDAVIT wervEe T RECORD.INSTR.NO. DATE >-
WORK TO HOUSE SEWER $3.00 I u
OVERFLOW SEEPAGE PITDRAINFIELD —�— CL
_ Im
EXTN.CES SPOOL.DRYWELL.MA NHOL"+E 0 $5.00
-9------- t-----t HWY. OR ST.WIDENING z
, ALTER,.R€PAI R.OR�BANDON HOUSE
SEWER ORD SPOSA t•SY�TE'[ - @ $3.00I ` STATE ENCROACHMENT
— -- - �I PERMIT NO.
--T --- -- INDUSTRIAL
I WASTE APPROVAL
���7�,7�D -""--" ---_ - CHARGES
OWNERPERMIT $ __ ' 0O— CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRI D EXISTING DWELLING -
TO THE PUBLiC SF J-� APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF -:4
OWNER ORN€W H
OUSE SEWER
OWNERS AGENT Z`li�''r T r "� ,t _"—
NECT ADDITIONAL
OR WORK
ADORES SEPTIC TANK SEEP,PIT(5)
I HEREBY ACKNOWLEDGE THAT I HAVE RE D THI5 APPTYWATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - _
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REP AIR,S EWER OR
LI_ NSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT.,1 AIN THE LEGAL OWNER OF, AND INTEND TO
DISCONNECT PLUG AND
RESIDE IN, THE AeO�E'Of SC RIB ED RESIDEN�'A�L PR PER7Y.
/ ABANDON N2}133E'SE'WR''
SIGNATURE
BACKFILL SEPTIC TANfiS ❑ r/
OF PERmrr EE_ "' f„_ —_ "� '" ._ ---- SEEP.PI715) ❑ CESSPOOLS ❑
VALIDATION JACK R. ALLEN
Ir SUPERVISING MECHANICAL ENGINEER
11.0 CASH
LA r a