HomeMy Public PortalAbout6548 OAK AVE_Sewer__ �. 24-wS0 INSERTS
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76AS42D APPLICATION FOR�. PERMIT �.
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETYDIVISION BUILDING
®HN A, LAMBIE,County Enggin or _ADDRESS k" r d
WILLIAM A. JENSEN, Salit of Builcling _LOCALITY
NEAREST
FOR APPLICANT TO FILL.IN _CROSS ST.
LEGAL t ,t'-' .,,�._ u #
DESCRIPTION LOT NO �..:j y ., OWNER j�f,-s� .: `.
BLOCK TRACT f' ADDRESS
6 r 'fir f`d &MAIL
Ili }A,r"
NO.OF BLDGS. y '°"% •'`x •.i :£',:
SIZE OF LOT NOW ON LOT ^' CITY �" TEL. NO,
USE OF .F „�``-
BUILDINGS {,"%` �,,,.x 4- !;..(� t- � DISTRICT N0, GROUP MAP --PROCESSED BY
BK PG
CONTRACTOR
ADDRESS ' t ; Pia CONNECTION DATA
CITY r� 4 d TEL,N0, f' Rr ' � STATION " DEPTH
rf' , E", STATE MANHOLE.REFERENCE.... :.!� UPPER
REGISTRATION N0, 'CF COUNTY _
NO DESCRIPTION OF WORK FE -
HOUSE SEWER CONNECTING TO _
PUBLIC SEWER CW $3.00
TYPE OF CONNECTION LENGTH FROM
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SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO F.L. r
PITS AND/OR DRAINFIELD @ $3.00
I OVERFLOW SEEPAGE PIT,DRAINFIELO
i
EXTN.. CESSPOOL. DRYW5LL @ $2,00
HOUSE SEWER CONNECTING TO J P.C.NO.
PRIVATEDPPOSAL SYSTEM @ $1.00 CO,IMP.N0. I JOB NO.
CONNECT ADDI TONAL.BLDG.OR 'TRUNK PERMIT NO. ROAD PERMIT NO. U
WORK TO HOUSE SEWER pSI.00
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1,00 PERMIT NO. O
fINDUSTRIAL
__WASTE APPROVAL a
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CHARGES tn
tn
OVINER'S PERMIT S Z r 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE I I REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER..
SIGNED THIS DAY OF 19 _ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGFIVI r 4. i.�f . BUILDING OR'WORK
..
ADDRESSSEPTIC TANK.,SEEP.PIT(S)
._.
---- 4 — AND/OR URAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ: THIS APPLICATION -
AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑. 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 R GISTEOD ANA/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGEL£5 ¢0 TY ANI?° "TATE OF
ABANDON HOUSE SEWER
'CALIFORNIA OR THAT, 1 AM THE LEGAL ¢�W. ER OF THE ABOVE
DESG'R13E,0 RESIDENTI•FI�'PROPERTY ,✓'� BACKFILL SEPTIC TANKS ❑
SIGNATURE (_ ""- 1 SEEP.PIT(S) L� CESSPOOLS OF PERMIT?
r / -�„ ATIOW}` ROBERT A. WOOD
t�f CK ta.o. (` CASH SUPERVISING MECHANIC-AL ENGINEER
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