HomeMy Public PortalAbout6640 OAK AVE_Sewer__ � r
CEBOB-6-59
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS I IOHN A. LAIKBIE.County Engineer
CASSATT D. GRIFFIN. $up'l of Building LOCALITY r � � '_✓ °
NEARESs
FOR APP TO F'ILI. IN caass ST.LEGAL
.J _
DESCRIPTION_ LOT NO.` A _- OWNER
BLOCK TRACT a ^mac '„ r ADA�REss
✓ NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL,NO.
USE OF
BUILDINGS �.-(� 8" s' DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR yr�«y ` jr BK PG
ADDRESS " :dONI�E TION DATA
CITY TEL.NO p Y STATION
—: DEPTH ,-
STATE
x ❑ MANHOLE REFERENCE' r. ✓ PPER.-'.
REGISTRATION NO y O COUNTY �. a` r z
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO J
PUBLIC SEWER. $9.00
YPE O: NNECTlON LENGTH FROM j
SEPTIC WANK, SEEPAGE PIT OR Y. -
ITS.AND/OR DRAINFIELD @ $9.00 Y• CURB,' P,L. tT M.L.TO P.L.
OVERFLOW SEEPAGE PIT..DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P C NO,
PRIVATE DISPOSAL SYSTEM _ Q $1.00CO.IIMF.N0. .s f ,1013 NO.
CONNECT ADDITIONAL BLDG.OR _ VTRUNK PERMIT NO. ROAD PERMIT NO.fps r
WORK TO HOUSE SEWER @ $1.00 } J °
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT —�
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
..v"-f 'WASTE APPROVAL
r
CHARGES
O w R'S'" PERMIT $ 22 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE `f ,i a_'' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALSDATE JINSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
TRACTOR TO CONNECT THE ABOVE DESCRIBED XISTING DWEL! G
--•—s-- — _
SIGNED THIS DAY "<— T> w . NEW HOUSE sEW£R i
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
- SEPTIC TANK,SEEP„PIT(S)
ADDRESS AND/OR DRAINFIELD
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. f SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY TH I AM PRO RLY REGISTERED ND/OR v
LIC= SED A REQUIRED Y LOS ANG E5 CO AND S ATE OF DISCONNECT PLUG AND
C ;IBE
OR THAT I AMTHE L AL OW ER. F T-A00 EABANDON HOUSE SEWER
LLLL��}}}}�S[DENT Ty. � BACKFILL SEPTIC.TANKS❑
SI NR ' gid
E .
PIT
tS) [] CESSPOOLS
MITTE
VALIDATION ROBERT A.WOOD
C"H SUPERVISING MECHANICAL ENGINEER
4