HomeMy Public PortalAbout5542 PAL MAL AVE_Sewer__ �rG G84650 JN
30 INS S
" APPLICATION FOR PERMIT
""A",42SeD COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ApDRESS
(OHN A. LAFIDIE, COuvtp Eng'veer '-
WILLIAM A. (ENSEN, Supt O4 SYildivq LOCALITY
NEAREBT �
FOR APPLICANT Tp FILL Ujicuoss sT.
LEGAL
DESCRIPTION LOT NO. _OWNER
BLOCK TRACT MAIL
_ADDRESS
NO.OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OF
BUI LDI_N GS DISTRICT N0. GROUP YAP PROCESSED BY
BK PG
CONTRACTOR
ADOREs32 ZLCONNECTION DATA/
CI - EL NO _ / STATION � DEPTH [,1
STATE MANHOLE REFERENCE I
REGISTRATION R0. LJ K.�C V COUNTY LOWER
NO. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ E3.00 PE OFN GTI LENGTH FROM
SEPTIC PITS ANO/OR DRAINFIELD 33.00
TANK, SEEPAGE PIT OR Y. IP.L. M.L TO P.L.
OVERFLOW SEEPAGE PIT. DRAINFIELD p
EXTN.. CESSPOOL DRYWELL @ 22.00 L L
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ SLOO CO. IMP. NO, JOB NO. N
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0. 0
WORK TO HOUSE SEWER @ S .00 _ U i
AEWER REPAIR SYSTEM
YST@ SL00
AIR OR ABANDON
HOUSE STATE ENCROACHMENT
PERMIT N0, FpF..
INDUSTRIAL p
WASTE APPROVAL NW
CHARGES w
OWNERS PERMIT E 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE t� REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. -
SIGNED THIS DAY OF 19_ NEW HOUSE SEVER
OWNER OR CONNECTAODItIONAL
OWNERS AGENT -BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL El
_
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
CENSED AS REQUIRE
LID LOS AN LES COUNTY AND STATE OF ABANDON DISCONNECT CT PLUG PLUGHOUSE AND
CALIFORNIA OR THAT TH EGAL OWNER THE ABOVE
WER
DESCRIBED REST ENTI OPE BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP PIT(S) CESSP LS
OF PERMITTEE
B' /'VALIDATION ROBERT A. WOOD
cA./J
M-0. CASH SUPERVISING MECHANICAL ENGINEER