HomeMy Public PortalAbout6531 OAK AVE_Sewer__ 74
6A g (' - CEtlOB - 9'73 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER ,T
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 531 Oatl/'t -
[LOCALITY 1eMle_Ci-tT
FOR APPLICANT TO FILL IN NEAREST
CROSS 57. tr
LEGAL L . 1J'lil lt�.l
DESCRIPTION LOT NO OWNER 5tha
MAIL 65JI 1 1)'ak
BLOCK TRACT - ADDRESSf'� /-('" 1�I�� (�
NO. OF BLDGS. 1eIT1�lE l itliL. NO. "T"T5-3`.�0�
SIZE OF LOT NOW ON LOT CITY
USE OF reS_-i(� DISTRICT NO. GROLUP MAP PROCESSED BY
BUILDINGS__ y, f SK PS
Universal Universal P1Umbing �''y� ,y ��y - -
ADDRESS ''�/(M_�ei v e . CONNECTION DATA
CI'pe . El Monte
lie TEL. NO. 575-346o STATION ��g-�-� _ DEPTH
1 018 UPPER
STATE `.2 LIC Q3 MANHOLE REFERENCE
LICENSE NO: -�! CLAS LOWER
NO. 1 DESCRIPTION OF WORK FEETYPE OF COrF TION LENGTH FROM
l HOUSE SEWER CONNECTING TO l l o o Y. r CUf$B_ P.L. M.L.TO P.L.
1 -�
PUBLIC SEWER $7.00
-- P.C.NO.
SEPTIC TANK,SEEPAGE PIT OR
TS AND/01 DRAINFIELD ;10.00 CO.IMP.NO. JOB NO.
PI
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO,� �
PRIVATE DISPOSAL SYSTEM ;3.00
CONNECT ADDITIONA4 BLDG.OR AFFIDAVIT ....R [ASt RtMT RECORD.INSTR.NO, DATE
WORK TO HOUSE SEWER @ ;3.00 Cl..
OVERFLOW SEEPAGE PIT.DRAINFIELD O
ALTER.
REPAIR O DABANDO. � 5.5.00 HWY.OR ST.WIDENING
ALTER.REPAIR OR ABANDON HOUSE - V
SEWER OR DISPOSAL SYSTEM ;9.00 STATE ENCROACHMENT O
PERMIT NO. V
MANHOLE $7,00
W
-- INDUSTRIAL o-
WASTE APPROVAL G7
OWNER'S PERMIT $ 00. - CHARGES
•i -
CONNECTION CHARGE FEE
AUTHORIZRTTON TOTAL FEE -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT
CFEE
*
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE.
SIGNED THIS DAY OF 99—
OWNER OR - NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS_
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S.)
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL Q
I HEREBY CERTIFY TH 1 AM PROPERLY REGISTERED AND/OR -ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFC.RNIA OR THAT THE,LEGAL W -ER OF, AND INTEND TO DISCONNECT PLUG AND -
RESIDE IN, THE ABD ESCRIBED TIAL PROPERTY, BANDON HOUSE SEWER
SIGNATURE ❑
ACKFILL SEPTIC TANKS
OF PE4tMTTTEE-- - _ - 'SEEP.PIT(S) ❑ CESSPOOLS ❑
I ATION CK, M.O. CASH
2 41.E t 4 J�J-