HomeMy Public PortalAbout6644 OAK AVE_Sewer__ &E-663 t5•S5
@ APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER —ADDRESS to -� ✓ fi---b= j:= �:x
CASSATT D.GRIFFIN, SOP'T OF BUILDING LOCALITY r l
7�AL
OR APPLICANT TO FILL IN _
NEAREST T i ,
COTNO OWNERMAIL TRAC_ _ADDRESS
NO.OF BLDG5.
_SIZE OF LOT _ NOW 0_N LOT -�_ CITY, f�s;"�.�.r¢' ��; TEL. N0,
USE OF ~^ 4 DISTRICT NO. GROUP - MAP
BUILDINGS-:_=. l _ =- -- •'.' >�.�' I BK PG
CONTRACTOR
ADDRESS-� CONNECTION DATA
ADDRESS i � ---�- - -- --'------ --- ---
STATiOfd5: -,,•� N J DEPTH
CITY _-.
——
�. TEL N@:., MANHOLE REFERENCE. r SUPPER
0-STATS
REGISTRATION NO ;�.• ,<::- ❑ COUNTY r NO, DESCRIPTION j DESCRIPTION OE'.WORK _ FEE -------._.___...--------.—...-----------------------------
HOUSE SEWER CONNECTING TO --- TYPE OFC A.,NT'CTI0N LENGTH FROM
l PUBLIC SEWER Y• CURS", P.i,. M.L. TO P.L,
C 3,50 - - --------- - -- .------
i SEPTIC TANK SEEPAGE PIT OR
PIIS AND/OR DRAINFIELD tt $3.,00 ---,--- ---.__ T —_--_.— -- ------
OVERFLO V SEEPAGE PIT,DRAINFIELD .�:. P. C. NO.
EXIN ,CESSPOOL,DRYWELL,h ANHOLE Ct y 2.00 I _i _.•,_CO IMP_ NO � j �> _ JOB NO,
HOUSE SFWER CONNECTING TO
j PRIVATE D SPO�AL SY 7RPM_ _ �c 3 1.00 ! TRUNK PERMIT NO ROAD PERMIT NO ,•° 0
CONNECT ADDITIONAL BLDG,OR. STATE ENCROACHMENT
WORK TO HOUSE SEWER rr S 1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE — -- --f----
SEWER OR DISPOSAL SYSTEM INDUSTRIAL
_. -- _t-... ID WASTE APPROVAL
i
CHARGES
CONNECTION CHARGE FEE - -
®VdNER°a PERMIT � - ------ ---
-- • --- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
APPROVALS D.;TE IiNSPECTO� SS,GNATURE
[ HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• ---__
TRACTOR TO CONNECT THE :ABOVE i ESCR-S:D EXISTING DWELLING '
TO THE PU,L;C SEWER, '! NEW HOUSE SEWER I.
SIGNED THIS _�DAy O�T�.t — —]9 - --- - --
- — CONNECT ADDITIONAL
OWNER OR i"�. ` � .�- BUILDING OR WORK I
OWNERS AGENT SEPTIC TANK,SEEP,PITtS)
ADDT;ESS ,-5 my%', x.sf -a-<-=-- �._..; AND'OR DRAINFIELD '-
I H£REBS' A �( O"VLED- F _HAT I HAVE R£i,D THIS APPLICATION CESSPOOLG DPYWELL[]
AND STATE TH' i THEABOVE IS CORRECT AND AGREE TO COMPLY
V,;TH ALL COUNTY ORDINANCES AND 5TATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEVv ER-S, _SEWAGE DISPOSAL SYSTEM
' HEREBY CERTIFY THAT l AM PROPERLY REGISTERED AND/'OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE' OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE "LEGA..L OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED-RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE
r ..�. SEEP. PIT(S) ❑ CESSPOOLS L
�c4 � _ -- -
OF PERM ITT EE - -.�'- - - �
JOHN A. LAMBIE, COUNTY EN61NIEER VALIDATION ROBERT A,WOOL), CHIEF PLBG. INSPECTOR
U. CASH