HomeMy Public PortalAbout5511 PAL MAL AVE_Sewer__' ]BABd2D
GEKLA a-6P APPLICATION FOR PERMIT
7
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
IOMN A. LAMBIE. County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt Ol Buildiaq LOCALITY
NEAREST
FO.11 AP C,1iNT TO IN CROSS ST. _
LEGAL
DESCRIPTION LOT NO. OWNER44
BLOCK TRACT MALL �J
ADDRESS
NO.OF SLOGS.
SIZE OF LOT NOW ON LOT CITY C L. N0.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR
71
ADDRESS CONNECTION DASA
CIT TEL.NO. G— S S STATION DEPTH
STATE MANHOLE REFERENC UPPER
REGISTRATION NO. S COUNTY LOWER
NO. DESCRIPTION 0 WORK FEE /1 y
HOUSE SEWER CONNECTING TO L G e
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
PITS ANPIC D/ORDRAINFGE DIT OR @ S3.00 Y. CURB P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EKTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ SLOO
ALTER, R PAIR OR ABANDON
HOUSE @ SL00 STATE ENCROACHMENT
SEWER PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGER
OMMER'S PERMIT S 22 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE n3 &V REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT THE CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTIINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S WE
SIGNED THI DAY OF 19IL(c NEW HOUSE SEWER
OWNER ORI CONNECT ADDITIONAL J
OWNERS AGENI-kq
BUILDING OR WORN
ADORES SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
IH
ACKNOWLEDGE THAT 1 HAVE READ THIS PPLI CATION
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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPE BACKFILLSEPTIC TANKS ❑
SIGNATUREC— SEEP.PIT S) ❑ CESSPOOLS
OF PERMIYTE +��G
®' U
CKALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENGINEER
ICOQ 4 4 9 0 "!. ? s 1 3 A 3