HomeMy Public PortalAbout6417 OAK AVE_Sewer__ rr& -662 t4.5� APPLICATION FOR PERMIT 1
E•b^u8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHNJOHNA, L_AMBIE, COUNTY ENGINEERADDRESS- ----............
—a�---
J CASSATT D. GRIFFIN, SUPT OF EI'UILDING LOCALITY
NEAREST T.-
_FOR. APPLICANT TO FILL IN -CROSS Sr, - +_
LEGAL t
DESCRIPTION LOT NO. OWNER'� -
;BAIL -
BLOCK TRACT ADDRESS
-�-- T NO. OF SLOGS.
SIZE OF LOT? NOW ON LOT CITY TEL. NO..
USE OF -- _ -- - -
_BUILDINGS p
' i. DISTRICT NO. GROUP MAP
CONTRACTOR ,
CONINECTIONI DATA
ADDRESSJ::' � - � -- -- .
--- --- - STATION „-"• DEPTH
CITY TEL F.0.
---- ----- -'-
MANHOLE REFERENCE !'-" - PPER i
STATE
REGISTRATION 140, ❑ COUNTY -=�-
NO DESCRIPTION OF WORK FEE - ^— - --- ---�- _�
_ _ --- T_ R-
HOUSE SEWER CONNECTING TO 1 Ph OF CQNNECTFON LENGTH FROM
I Y. CURB P.L. M.L.TO P.L.
I PUB IC EWER L $`s.50, ! �_ -- -- --- ---
T I SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAiNF IELD Ca, $3.D0
OVERFLOW SEEPAGE PIT,DRAINF.IELD + - P NO. .. -
FXTN,.,CESSPOOL,DRYWELL,MANHOLE (0) $2.00 j CO. IhlG N0. JOB
PRIVATE
SEWER CONNECTING 70. - ,.0 _--- --- TRUNK PERMIT NO. ROAD PER"IT NO.
� PRrV�A'F'E DISPOSAL SYSTEM (i $± r, I ^>
CONNECT AllDiTiONi.l.BLDG.OR I STATE ENCROACHMENT -
WORK TO HOUSE SEWER fci' $I.GC PERMIT NO.
-1-7 j ALTER,REPAIR OR ABANDON.HOUSE INDUSTRIAL
1 SEWER OR DISPOSAL SYSTEM _ r $t_0 I_ _ � WASTE APPROVAL
{ CHARGES
CONNFLfi.ON CHAR.L FLT.
OWNER'S PERMIT11 00
i
S
---
AUTHORIZATION TOTAL FEE �-- I REIMBURSEMENT FEE T�a
1
i HAVE AT TE1S DATE P. CONTRACT WITH THE HEREIN NAMED CON- -_-._.._APPROVALS DATE 1NSPECTOR'S SIGNATURE_---------._--
TR'ACTOR TO CONN-CT THE ABOVE DESCRIBED EXISTING DWELLING j
TO THE PUBLIC SEWER. NEIN HOUSE SEWER
SIGNED T IS_.._-_._DAY coNN£cr ADDITIONAL
OWNER O.R - BUILDING_OR WORK:---
OWNERS IAGENT-----. ._ -__--_•--- -- SEPTIC TANK.SEEP, PIT(Si !
A0D-RESS. AND/OR DRAINFIELD j
I HEPEBY A KNONLEDGIE THAT I HAVE READ THIS APPLICATION CESSPOOLri UFY t:L J
AND STATE TY c+ +!+.E ABCVE IS CORRECT AND ACh_E T6 COMPLY
Vi[TH .ALL COUNTY ORDINAN'lFS AND STATE LAWS REGULATING -ALTER,REPAIR,SEWER OR - --- --�-- __.--
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM --DISCONNECT
C LUG AN—. _- ------ '---.._-- ---- —...
PROPERLY REGISTERED AND/OR ,
LICENSED AS REDUIPED BY LOS ANGELES COUNTY AND STATE OF ABA DNN H PLUG AND
CALIFORNIA OR -THAT I AM THE LEGAL OWNER 01 THE ABOVE ABANDON HOUSE SEWER j
DESCRIBED Rf_:S xCNT(AL PROPERTY. BACKrILL SEPTIC TANKS v I
SEEP. PII(Sj L CESSPOOL 1
CF PERMITTER-
JOHN
ERMITTEE-JOHIN A, LAMBIE, COUNTY ENGINFER VALIDATION ROBERT A. WOOD,CHIEF PLOG. INSPECTOR
CK. X.O. CASH - -