HomeMy Public PortalAbout6540 OAK AVE_Sewer__ C
45A642D 63 APPLICATIL6N FOR S_'_ECt IT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL ",G
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
JOAN A. LAMBIE. County Engineer aD�R::ss •' `-- -v— '—
WILLIAM A. JENSEN. Supt of Building
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NEAREST
FOR APPLICANT TO FILL IN CROSS
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SIZE_ OF LOT NOW ON LOT CITY TEL. NO.
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USE OF
HWILC'INGS DISTRICT NO. GROUR - MAP PROCESSED BY
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CONTRACToyr `�a •�• _ Y� �` _�i_ d #{ 3 ) _ I?_ ,: _
ADDRESS ,-. CONNECTION DATA_,
STATON
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STATE MANHOLE REFERENCE FA. +�
REGISTRATION NO J COUNTY 'T� f_ --LO ER
NO. DESCRIPTION OF WORK FEE :-TYPE OF CONNECTION { LENGTH FROM - _- _-_
__.-_ -_..____------ 1._._��_�..
7-HOUSE SEW€R.CONNECTING TO ! K�I f Y. CURB P.L. M.L.70 F.L.
PUBLIC SEWER @ $5.00
JOB NO
P AINF,ELC $t0 Otl
.S AND/OR DRCO IMP' NO... _.��'' _
r.
F'6UsF:SEWER CONNECTING TO ---- TRUNKPERMIT NO. ROAD PERMIT
PR VATS DISPOSAL SYSTEM $3.00
NO
CONNECT ADDIT!ONA BLDG.OR -----_.y- '--- - AFFIDAVIT WAIVER EASEM&NT� T
J RECORD.!NSR. T�DATE
WORK TO HOUSE SEWER $3.00
OVERFLOW SEEPAGE PIT,DRAT NIFELL
EXTN.,CE5SP^OL,DRYWELL.MANHOLS $5.00
------h— - - --- — HWY.OR ST.WIDEMiNG
! A TER,RF PAIR OR ABANDON HOUSE !. en
SEWER OR DISPOSAL.SYSTEM Q $3.00 STATE ENCROACHMENT �_ _�,._
—__— PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT az 0 --- E
CHARGE
CONNECTCHGE FE
AUTHORIZATION TOTAL FEE --
'I HAVE AT 'THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMSURSEMENT FTE
TRACTOR TO CONNECT THE ABOVE DESCRIBED XISTING DWELLING -- APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS PF—
OWNER OR NEW HOUSE SEWER
—_.-
OWNERS P.G'ENT._ CONNECT ADDITIONAL. 1 1
BUILDING OR WORN j
ADDRESS—
_-- _ - SEPTIC TANK.SEEP PIT(S) I
I HFREBY Ar.KNOWLE'DGE THAT I HAVE READ THIS APPL CAT'iON AND/OR DRAINFIFLD '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL. COUNTY ORL'INANCES AND STATE LAWS RF_GULATING - --- - — - -_-----
CESSPOOL n DRYWELL
PLUMB!NG AND SEWERS � ---ILL---
1 riEREBY .CERTIFY THAT I AM. PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR -~-
LICL'NSED AS REQ' QED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
>^• 1?"uRM A OR I AM THE' L�'GAWNER 7F, FND iCtTENC TCT CTPLUG ANDRs. ;[? IT. TH H' IE OESCR!SDEN AL. ROPE RT Y, ABANDON HOUSESEWF.R
rGNATt RL 9 F3AC'<FIL.L5EP71<.T.lNKSP RMInF - — —__--._._. ____ .____ SE-i'.P.iY IS) I] CESSPOOLS I '
VALIDATIO'Wt- ROBERT A. WOOD
SUPERVISING MECIHANICAL ENGINEER
CK. M.O. CASH
LICO 670 6 CGT 221 D 7.00- q