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HomeMy Public PortalAbout6460 OAK AVE_Sewer__ 5&EAPPLICATION FOR PERMIT 1 5&H•663 ft-55 DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING — JOHN A. LAMBIE, COUNTY ENGINEER — CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY - -- 1 _ _ FOR APPLICANT TO FILL IN — cII©ss sr. LEGAL DESCRIPTION LOT N0./ �'- OWNER -Z, - - _ BLOCK TRACT —.ix MAIL i_; - / --� ADDRESS — NO. OF BLDGS.` —SIZE OCITY TEL. N0, F_L_OT O %' -�i�.,$" �.y_ _ NW ON LOT USE OF �� BUILDINGS --i..-.:..t �°"'li'='c....r DISTRICT NO. GROUP MAP --_= ?K PG CONTRACTOR --� ADDRESS =tea. �.� �s CONNECTION DATA" K --- - T �' "� i� - CITY -���,-.r � EL. NO. � STATION � � � DEPTH — `- r+j, MAN40LE REFERENCE UPPER D-6ATE ---- --- .__--- _-- REGISTRATION NO. _.._ ". '� COUNTY - N0. DESCRIPTION OF WORK FEE --_ TYPE OF TION LENGTH FROM --- HOUSE SEWER CONNECTING TO k - Y RB P.L. M,L.TO P.L. PUBLIC SEWER @ $3.50 G -- — ------ - ---- SEPTIC TANK,SEEPAGE PIT OR j PITS AND/OR DRAINFIELD {rig $5,00 OVERFLOWS EEP AC£PIT,DRAINFIELD ' P. C. NO. _ EXTN.,CESSPOOL.DRYWELL,MANHOLE (�i' $2.00 CO. IMP. NO, 1 108 NO. _ jHOUSESEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM d $1.00 'TRUNK PERMIT NO, ROAD PERMIT NO_ t-- k CONNECT ADDITIONAL BLDG OR - -- ---�— � � STATE ENCROACHMENT 3 WORK TO HOUSE SEWER (c( $t,00 PERMIT NO ALTER,REPAIR OR ABANDON HOUSE- -- ----�-- INDUSTRIAL--- -- --- --. ---- SEWER OR DISPOSAL SYSTEM _---n i:.00. WASTE APPROVAL, i CHARGES t CONNECTION CHARGE FEE OWNER'S PERMIT 1 00 — --- — REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE - tT i� APPROVALS DATE IINSPECTCR'SS;GNA.TURE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- _ TRACTOR TO CONNECT THE ABOVE DESCRIBED EAISTING DWELLING i TO THE PUBLIC SEWER. -- — NEW HOUSE SEWER SIGNED THIS " DAY,aOFCONNECT ADDITIONAL — OWNER ORBUILDIN OR ¢ORK I i ' ;,". OWNERS AGENT � J + -- --- SEP?1C TANK,Site PIT(S) ADDRESS, 3C_ 9B ' ./��' Q" •�' iC.,''yf' .^,ND,�UR DrtAINF1ELD —.----- --- - -j ---`-- - ---.-- HE ACKN041 LEn E THAT I HAVE Rk.AD THIS APPLICATION GESSPGUL{�� DRYVJELL[] AND STATE TI^_T THE ABOVE CURRECI AND AGREE TO COMPLY --__._ WITH ALL COUNT, ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR - PLUNI,B;NG AND SEWERS. SEWAGE DISPOSAL SYSTEM j-- --- .-------- 1 r;�'RE35Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ------ DISCONNECT PLUG AND LICENSED AS REQUIRED BY LCIS ANGELES COUNTY AND STATE OF ' k CALIFORNI A OR THAT t AM THE LEGAL OWNER OF THE ARARAN DON.OVE HOUSEEWER — — -- -------------.-.--_ DESCRIBED fiE 1JEN""'A� L„PROPERt EACKE t L SEPT C TANKS L SIGNATURE f - 7 -' 4 .y- FEP.. PIT(S) EJ_ CESSPOOLS <�+ ��^ �✓'�' ..,-• ,�' ,,'" � ---- ---_--_. OF PEAM91i'TEc. i IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOL), CHIEF PLBG. INSPECTOR CK: y CASH -