HomeMy Public PortalAbout5340 PAL MAL AVE_Sewer__ =n
CE808I l " � . APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Eu NOYr ADDRESS J =NO.CASSATT D. GRIFFIN, SuPt o! Buildin0 7LOCALITY FOR APPLICANT TO FILL IPI CROSSST.LEGALDESCRIPTION L 0. OWNERw OF LOT MAIL
BLOCK ADDRESS0 BLOGS.S1TE OF LOT NOW ON LOT / CITY
USE OF
BUILDINGS Z DISTRICI NO. GROUP MAP
/
CONTRACTOR j/-AJ ( �0 `/C/f BK PG
ADDRESS 07 CF!/7-b 5? p '' CONNECTION DATA
CITY S TEL.NO. / STATION DEPTH
,
REGISTRATION NO. �p _ Z STATE MANHOLE REFERENCE PPER
No. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S S.SO TYPE OF CONNECTION LENGTH FRcjx
SEPTIC TANK,SEEPAGE PIT OR CURB P.L. M.L.TO P.
PITS AND/OR DRAINFIELD @ S2.00 L.
OVERFLOW SEEPAGE PIT.DRAINFIELD
EKTH..CESSPOOL.DRYWELL,MANHOLE @ $E.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.INP.N0. I JOB N0.
CONNECT ADDITIONAL BLDG.OR O
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNWS PERMIT S 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE pEIMBURSEMENT FEE
TRACTOR TO CIONNECT THE ABOVE EDATE A CONTRA1SCR BED EXISTING THE HEEICON.
L
APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS D 0f19_ OUSE SEWER
OWNER O.. ECT ADDITIONAL
OWNE0.5 AGENT 1� ING OR WORK
ADDRESS C TANK,SEEP,PITISI
R DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYOOL DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,REPAIR.SEWER OR
PLUMBING AND SEWERS. E DISPOSAL SYST1HEREBY CERTIFY THAT I AN PR RLY REGISTERED-AND/ORISCONER PLUG AND
LICENSED AS REQUIRED BY AN LES CQ TY AN STATE DON HOUSE SEWE0.
CALIFORNIA OR T T 1 THE EGAL ER 0 THE OVEDESCRIBED RESIDEN L OPERT I LL SEPT IC TANKS ❑SIGNATURE A, PITS CESSPOOLS ❑
OF PERMITTE
or ` 11 VALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENGINEER
LAC03 7 2 3 AUG 11 10 A 4 -50
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