HomeMy Public PortalAbout6453 OAK AVE_Sewer__ �BA6 z~ APPLICATION FOR PERMIT 1
a&Yi.65?19.59
)TVISION OF BULLD-ING AND SAFETY SEWER—SEWAGE DISPOSAL
r ,.Tmrtmenl of Counliy Engineer
Ccs :,5 l� z;."eles
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D.GRIFFIN, SU?'T OF BUILOINc,`: " -
LOCAL[TY £ _
NEAREST lop,
_
_ F® APPLICA T TO FILL ICROSSST
LEGAL __-�_—�—.` a�6��'���a -
nEscRlPxioN LOT No, .� f cf _ OWNER f`
�_ - f � raa1L „
BLOCK TRA .er ,' -. ,-�. ..— ADDRESS ,
- NO. OF BLOCS. CITY TEL. N0.
SIZE OF LOT �,� - ;�r NOW ON LOT
1,USE DFNGS_ `N. �� _ DfSTRIC GROUP MAP
PG
'� _
CONTRACTOR `
--- -
ADDRESS;� ���f CONNECTIONDPaTFi F
"""" �- ;� ,±�',y� �"` STATION - .—..,'DEPTH r
CITY . - - _f�!��• vgEL. NO.f e:. _-
�. s-S se crt' X9 HOLE REFERENCE - .4" , '^ UPR£
,� ['�'STATE
REGISTRP.TIOII N0. _ COUNTY - - ------
No. 1 DESCRIPTION OF WORK FEE
�I HOUSE SEWER CONNECTING TO — — TYPE 0�F.,,GQttL(�j,ECTFON LENGTH FROM ,r
PUBLIC SEWER _ __ __ ala 3.50 I f ,.: '-+�- CURB'�;� P.L. P T.TO P.L. u�.I^ --
SEPTSCTANK,SEEPAGE PIT OR---------
P TS AND/OR DRAINFIEL.D CX 3.00 I ----- - — -
oVE.RFLo- SEEPAGE PIT DR—Al NFFELD -- --- P. C. NO, -
EXTN„CESSPOOL,DRYW ELL.MANHOLE ti $2.OD 1 CO. IMP. NO— JOB N0. -
--- --r-'—' ,F -----
- ----
- —d HOUSE SEINER CONNECTING TO t I R�
( PRIVATE DISPOSAL SYSTEM rt, $
'1.00 I TR_U_N_K PERMIT N0. _ ROAD PERMIT N4(_&' 76-
CONNECT
-- _ 6 -
CONNECT ADDITIONAL BLDG.OR ------� _-� STATE ENCROACHMENT -------- —
1 WORK TO HOUSE SEWER c $1'0") L — PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE � INDUSTRIAL
SEWER:OR.DISPOSAL 5YSTEIA-- � $-1.OQ WASTE APPROVAL
�! CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s I l 04 --- --- ----------
AUTHORIZATION TOTAL FEE _ — REIMBURSEMENT FEE
I HAVE AT THISDATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS _DATE I(IN$PEC'OR $SfGNA7'URE
TRACTOR TO CONNECT THE ABOVE LLSCRIBED EXISTING DWELLING —
TG THE PUBLIC SEWER
NEW HOUSE SECONNECT ADDITIONAL
INER {{{
SIGNED THIS OF /' '� - -- �.-------- - —-- -- -- --
OWNER OR. r BUILDING OR ><vORk
OWNERS AG,ErNT $rnT C TANK 5ECF
. , i
ADDRESS y9 � �,.x" s_'sf'` i'��,�. AND,OR DFA11•dFIELDP .-----
I HEREBY ACKNOWLEDGE THAT I HAVE READ. THI�-PL.CATI N -- - ---�--- �
CESSPOOL❑ DRYWELLl7
AND STATE TPA! THE ABOVE IS CORRECT AND AGREE TO COMPLY ----- _-..-- __._-- -------_._f-.-_.—.--
WIi'H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR �
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEhEB'! CERTIFY THAT '1 A.:d PROPERLY REGISTERED AND!"OR DISCONNECT PLUG AND t
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE L" � OWNER OF THE A"dOVE
DESCRIBED RESIDENT( ROPERTY., BACKFILL SEPTIC TANKS L
e SEEP. PIT Sj Ll. CESSPOO S�j
SIGNATURE. i
OF PERb13TTEE J --__ ,'`
I
1OHN A. L.AMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF F'1-13G. INSPECTOR
CK. N. 9
. ,