HomeMy Public PortalAbout6506 OAK AVE_Sewer__ 'fisc$ a APPLICATION FOR PERMIT �' 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF CO'U'NTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS -
JOHN A. LAMBIE, County Engineer -
CASSATT D. GRIFFIN. Sup't of Building LOCALITY
NEAREST
FOR .APPLICANT TO FILL IN _CROSS ST.
LEGAL OWNER ;.
DESCRIPTION LOT NO. -
BLOCK -_. TRACT - MAIL -
-- ADDRESS
NO,OF BLDeS,
SIZE OF LOT NOW ON LOT T CITY _ F.L.N0.
USE OF T
BL'ILTDING3 DISTRICT NO. GROUP/ MAP PROCESSED Ji
T�®
BK FG �
CONTRACTORAble' '
- i..—
ADDRESS 225 1[ rya- - CONNEC'T'ION DATA
CITY '71 VnnteTEL_NO.Gj
q4r, STATION -r DEPTH
STATE
REGISTRATION NO, r s COUNTYMANHOLE REFERENCE .
NO. DESCRIPTIO OF W01ZK FEE --- � •r
0 SE SEWER CONNECTING TO
P I LIC SkWI R_ C $3.00
SEPTIC TANS, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
—PITS AND/OR DRAINFIELD @ ..$9.00 I _Y• CURB P.L, M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRATNFIELD
i £XTN..CESSPOOL,DRYWELL,MANHOLE @ .$2.00
HOUSE SEWER CONNECTING TO P.C. NO.
P PRIVATE DISPOSAL SYS TEM (il $1.00_ CO.IMP,NO. JOB NO,
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO./ ROAD PERMIT NOS Tt
_
( ALTER,REPAIR OR ABANDON HOUSE YSTATE ENCROACHMENT --
I SEWER OR DISPOSAL SYSTEM $I.OQ _PERMIT NO.
— INDUSTRIAL
4 WASTE APPROVAL
CHARGES
MMM'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AFT'I'HORIATION TOTAL FEE .`' REIMBURSEMENT FEE —
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRISED EXISTING DWELLING
TO THE PUBLIC SEWER,
SIGNED 'THJS DAY 0F____0___19____ —NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER 0R _ - BUILDING OR WORK
OWNER.SAGE1[T
SEPTIC TANK,SEEP, PITS)
AbDRESS ----- —__— —_ AND/OR DRATNFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL[I DRYWELL
WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANA/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 4BANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI,,L PI$OPERTY. 3ACKFILL SEPTIC TANKS❑
SEEP.PIT(S) {� CESSPOOLS E
SIGNATURE _ � ,.�I _
OF PERMIT?
�Ir, -VALIDATION ROBERT A.WOOD
M.O. CASH SUPERVISING MECHANICAL ENGINEER
! 7 79b , 7 .