HomeMy Public PortalAbout5636 PAL MAL AVE_Sewer__ ;:QA;,1, as APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engin.
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER
ADDRESS
T
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
NEAREST / t
OR APP CANT TO ILwo 'A T CROSS ST h ((C
LEGAL _ OWNER
DESCRIPTION LOT N It
BLOCK TRACT 2 —G 100RESS ,JAG 3 G a. 211'1
/ I OF BLOBS �/ � G/ / / /
SIZE OF LOT Y O ZOO NOW ON LOT 7 CITY TEL NO
USE OF
BUILDINGS 3 f. DISTRICT NO GROUP YAP
BK47
P6
CONTRACTOR �...� `
CONNE PION DATA
ADDRESS
CITY TEL NO STATION DEPTH
MANHOLE REF RE! UPPER
[ISTATE OWER
REGISTRATION ❑ COUNTY
NO DlESCRIPTION OF WORK FEE a_elfff 47 '44 7w
HOUSE SEWER CONNECTING TO TYPE 0 ONNECTION LENGTH FROM
PUBLIC SEWER Q S 3 50 Y fl8 P L N L TOP L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® S 3 00 _
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE 0 $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM B $1 00 TRUNK PERMIT ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENC R HMENT
v WORK TO HOUSE SEWER ® $I DO -v PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTR L
SEWER OR DISPOSAL SYSTEM ® j 100 WASTE A PROVAL
CHARG
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
AUTHORIZATION roTAL FEE
.4v
REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAMEU CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR _ BUILDING OR WORK
OWNERS AGENT SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THEABOVE
DESCRIBED RESIDENT L PRO PE I BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PER NITTEE
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBJERRT ASWOOD CLLHIEF PLB//GGA�INSSPECTOR
Ltoi72ON JUN 10 4 A- 2.00 �