HomeMy Public PortalAbout5527 PAL MAL AVE_Sewer__ $ to-BB
Aa4 APPLICATION FOR PERM1t
C E308 0
COVENT OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPAR7FlENT OF COUNTY ENGINEER
SUJEpLIDDp7IING AND SAFETY
� DIgV�IvSION iOUILDIae
WILLWdAA ZN Co—LAMM uf DlfB ddmq
LOCALITY C
NEAREST
FOR APPLICANT TO FILL IN DRDEE B'
LEGAL _
OLBCRIPTION LOT HO A OWN
MAIL
BLOCK TRACT AODRE6
NO OR SLOGS ice'
SIZE O! LOT NOW ON LOT CITY ( C TEL NO �O
USE DI DISTRICT NO GROUP MAP P P-0B8D BY
BUILDINGS
I
CONTRALTO9—A..RE[B Q 6�/ CONNE DE[TArlon O[PFN
SMANHOLE REFERENCE UPPER
RCOIiTRAT10N n0 / / CLOWER
NO DESCRIPTION OF WORK FEE TYP NN[CTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y URB P L ML TO P L }
PUBLIC SEWER 0 Sam
SEPTIC TANK SEEPAGE PIT OR3;7 PC NO 4
PITS AND/OR GRAINFIELD O SIO DO CO IMP NO JOB NO O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V
PRIVATE DISPOSAL SYSTEM l3oo DC
CONNECT ADDITIONAL BLDG OR AFFIDAVIT RMY[L IA1[RYMT RECORDINSTR NO OAT[ O
WORK TO HOUSE SEWER C SS GO j
OVERFLOW SEEPAGE PIT GRAINFIELD
MXTN CESSPOOL ORYWELL MANHOLE• EBOO
RSR ABANDON XOUBE HWY OR BT WIDENING
$3 00 STATE
NCROACHMCMT
PERMIT
P[RNIT NO
INDUSTRIAL
WASTE AP AL
CHARGES
OWNFR'3 PESMIT s z o0
AUTHORIZATION NOTAL FEE /� CONNECTION CHARGE PL[
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_
OWN ER OR W
OUSE SEWER
OWNERS ADEN T
CONNECT ADDITIONAL
ADDRESS NG ORWORK
HEREBY ACKNOWLEDGE THAT I HAVE READ j
TION TANK SEEP PITIS)
AND STATE THAT THE ABOVE IB CORRECT AND AMPLY R dfA1NP1[LO
WITH ALL COUNTY ORDINANCES AND STATE LTINGFLU MoING AND SEWERS OL ❑ DRYWELL ❑1 HEREBYCERTIFY THAT 1 AM PROPERLY RED�OR REPAIR SEWER ORLICENSED AB REQUIRED BY LOS ANGLES COUN [ OP E DISPOSAL SYSTEMCALIFORNIA OR THAT I AMTHE LEDALOWNER OTOC61DE IN SOV[ O[l EO RESIO TINECT PLUG ANpON HOUSE SEWERLL SEPTIC TANKS ❑ITIS) ❑ CESSPOOLS
VALIDATION ROBERT A WOOD
CK M O CASK SUPERVISING MECHANICAL ENGINEER
5 9 8 1G FES 27 1 0 D 5.00-
_