HomeMy Public PortalAbout6347 OAK AVE_Sewer__ 76AE-66 APPLICATION FOR 06MIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL,
Deportment of County Engineer
County of Los Angeles BUILDING 1
JOHN A. LAMBIE, COUNTY ENGINEER ADDREss ,
CASSATT D, GRIFFIN, SUP'T OF BUILDING C
LOCALITY
- FOR APPLICANT TO "FILL IN NEAREST
cRoss
_ sr.
LEGAL -
DESCRIPTION LOT NO. � 1 4 �� :e OWNER �
BLOCK TRACT a. —per qIL
0 y
NO. OF BLDGS.
_SIZE OF LOT
NOW oN r + d , . "- CITY TEL. NO.
LOT 1 ,a ¢_
USE of
BUILDINGS DISTRICT No - GROUP MAP
_'— BK PC
CO-NTRACTOR
CONNECTION DATA
.ADDRESS
rSTATION • DEPTH
_
CITY _ __�-_ rEt'�����77�tFFt0. J t — —�
MANHOLE REFERENCE ? UPPER
i
TATE LOWER
LOWER
REGISTRATION NO, -
N0. ; DESCRIPTION OF WORK.. FEE
----- --- -- -- TYPE OF C TION LENGTH FROM
HOUSE SEWER CONNECTING TO -- = - ..-� '
PUBLIC SEWER a'7 $3.50 I°'`} Y. RB 'p. P.L. M.L. TO P.L. ,�'
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD_ hI $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD --- ��------- "p _ PC NO.
A FXTN.,CESSPOOL,DRYWELL,MANHOLE s i 2.00IMP. NO,CO. IMNO,
HOUSE SEWER CONNECTING TO —
PRIVATE DISPOSAL SYSTEM I $1.00 I - TRUNK PERMIT N0. ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR – -------"-- _, --
WORK TO HOUSE SEWER ( $1.00 � � STATE ENCROACHMENT
-- _ --- _.. _ __ ' °" -- PERMIT NO-
PA
O ---
I ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'SPERMIT $ 1 Do REIMBURSEMENT FEE _._____--.----,---_ _---
AUTHORIZATION I TOTAL FEE —_ � —
` I
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS F,T !NSPECTOR'SSIt;NATURE
TRACTOR TO CONNECT THE ABOVF. DESCRIBED EXISTING DWELLING -
TO THE PUBLIC SEW,ER. NEW HOUSE- SEWER
SIGNED THIS---DAY OF 19_.__ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT -- - SEPTIC TANK SEEP PIT IS)
AND/OR DRAINFIELD - i
HEREPY ACKNOWLEDGE E THAT I H YE READ THIS APPLICATION
CESSPOOLLI URYWELL�YJ
AND alA 1H'T HE ABC Y'E IS CCR EiCT AND AGREE TO COMPLY -.._— --
-- -
111TH T LL i;UUNIY ORDINANCES AND STATE LA"NS REGULATING ALTER REPAIR SEWER OR �
PLU HFRIEI AND SEWERS J AND STATE OR SEWAGE DISPOSAL SYSTEM - I_T.
r
1 ur a -_— - --- ----- .�.— ---- --
LY CERTIFY T AT 1 AM PROPERLY PEG1S ERFD AND/OR 1
L.LENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG P,t3D ( t
CALIFORNIA OR THAT 1 AM THE LE OWNER OF THE ABOVE _ABANDON HOUSE EWER
DESCR13ED RE .WoN L PRO"ERIY. BACKFILL SEPTIC TANKS
SEEP. tIl(Si CESSPOOLS 1.1—,— _.� - -^-"----
SI-GNATURE \. _ _-._ ._..
OF PERMiTTEE.r 9 5y-._ �'�'•'
JOHN A. LAMBIE, COUNTY ENGINEER VRLIDA'TION- t�yOBERT A. WOOD, CHIEF PLESG. INSPECTOR
CO3 3 f GASH ,✓'
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