HomeMy Public PortalAbout6423 OAK AVE_Sewer__ CEA&8�D'CE$O$ APPLICATION FOR PERMIT
11-57
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMME, County EngineorADDRESS
CASSATT D. GRIFFIN, Supt of Building -LOCALITY
I NEAREST
FOR APPLICANT TO FILL IN CROSS ST. _
LEGAL -
DESCRIPTION LOT N0. .� t..�--'° --4- ^`'C OWNER .- --.--
BLOCK TRACT MAIL
ADDRESS _
N0.OF BLGGS.
SIZE OF LOT 4 i 1 NOW ON LOT CITY TEL.NO.
USE O dSTATE
BUILDINGS T ,a DISTRICT NO. GROUP MAP
CONTRACrOR'_A
DDRESS yCONNECTION DATA
CITYTEL :'. _ STATION . - =- �:, ^DEPTHREGISTRATION N0. fMANHOLE REFERENCE ° �UPPER' " --NO. DESCRIPTION OP WORK FEEHOUSE SEWER CONNECTING TO
UBLIC SEWER @ $3,
TYPE OF(tD - ION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT 0R Y. )CURB P.L. M.L,TO P.L.
PITS AND�OR DRAlNr`IELD @ $3,00 -
OVERFLOW SEEPAGE PLT,DRAINFIELD ----`�
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C,N0.
PRIVAT_F.DISPOSAL SYSTEM_ @ $1.00 CO.IRIP.NO. �: JOB N0.
COT .ADDsrION.-'� L OR y:
WO $ R k ' TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE -- --
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
- CHARGES
OWNER'S PERMIT s 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE r' _)
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRAWITH THE. 14EREIN AMED CON
TRACTOR TO CONNECT THE AB VE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEVIER. -
S[GNED THIS--_DAY OF-___-, _NEW HOUSE SEWER _
OWNER OR CONNECT ADDITIONAL ro
OWNERS AGENT - _BUILDING OR WORK _
ADDRESS_-.- _ e' f 5.:.v.�. SEPTIC TANK,SEEP: PIT(S)
.�- _ ---- --_--- AND/OR DRAINF1ELD --'-
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL ❑
WITH ALL COUNTY QRDiNANCES AND STATE LAW'S REGULATING -- -
PLUMBING AND SEWERS. ALTER,.REPAIR,SEWER OR
I HEREBY CERTIFY TIIAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM _
LICENSED AS REQUIRED BY IAS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND ~�
CALIF,pR7f)A OR THAT I AM THE LEGAL OWNER OF THE ¢�BO.VE ABANDON HOUSE SEWER
DFS IBE17 RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS CI
jst TU .- SEEP PIT(S) L1 CESSPOOLS '
PER
f
®e - VALIDATION ROBERT A. WOOD
CK. . M.o.. ,� CASH SUPERVISING MECHANICAL ENGINEER.