HomeMy Public PortalAbout6447 OAK AVE_Sewer__ AP�LICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWED-SEWAGE DISPOSAL. 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION nnneEssG
JOHN A. LAMBIE, County Engineer
GASSAIT D. GRIFFII`i, Supt of Building LOCALITY
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FOR AP CANT TO ISI
NEAREST.senv L �✓'
LEGAL Je v y'.
DESCRIPTION LOT G O. a� OW ER
BLOCK TRACTS`✓ � MAIL
J'L �' '. ' ADDRESS ,f
Nd.OF BLDGS. r
SIZE OF LOT �Y. /j NOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS - DISTRICT N0. GROUP MAP PQ - PROCESSED BY
CONTRACTOR I ag ,. ; _f �® y �� �r ;• r—}
ADDRESS q
CONNECTION DATA
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CITY l+ ,� TEL.N0. STATION DEPTH
e STATE
REGISTRATION NO. d ' A COUNTY MANHOLE REFERENC UPPER_
LOWER
NO. I DFSCRiPTi4 I�OF WORK FEE
i HOUSE SEWER CONNECTING TO �L4`'1 , .
PUBLIC SEWER @ $9.00 11
SEPTIC'TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PtT5 AND/OR DRAINFIELD @ $3.00 Y. CURB P.L M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL,DRYWELL,MANHOLE @ $2.00 _
HOUSE SEWER CONNECTING `AD P N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 _ CO.IMP.N0. -- OB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. :�' D PERMIT N0.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACH
SEWER OR DISPOSAL SYSTEM ( $1.00 _PERMIT N0
SNOUS'WAy
WASTE AI ?ROVAL
_ CHARGES
OWNERS PERMIT 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE : + Ir
J REIMBURSEMENT FEE
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I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED TENS DAY OF qg� NEW HOUSE SEWER —
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS_ - - AND/OR DRAINFIELD -
I HEREBY" ACKNOWLEDGE THAT € HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HE-REBX CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGkL—OWNER OF THE Al I --
DESCRIBED RESIDENT(;AI. PROPERTY. BACKFILL SEPTIC TANKS[Ir SEEP.PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTE `
gir -VALIDATION ROBERT A.WOOD
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CK.
,r f N.0. CASH SUPERVISING MECHANICAL ENGINEER
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