HomeMy Public PortalAbout5421 PARMERTON AVE_Sewer__ • �' 44650'INSERTS
'7GAeuD�D APPLICATION' FOR PERMIT --, •1 --'r
COUNTY OF LOS ANGELES SEWER-.SEWAGE SEWAGE DISPOSAL , `
DEPARTMENT OF COUNTY ENGINEER" BUILDING (
' BUILDING AND SAFETY DMSION ADDRESS J CLQ I
JOHN A LAMBIE Coua1T I I y -
WILLIAM A JENSEN Supl of BvildlnB LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO 1 OWNER T
BLOCK TRACT ,MAIL
^ADDRESS { ��-fir`•
0 OF BLDGS
SIZE OF LOT NOW ON LOT CITY
USE OF
BUILDINGS DISTRICT
STRICT NO GROUP MAP
P SED BY
CONTRACTO ;
ADDRESS SO ��, r CONNECTION DATA
CITY / TEL NO C { C G I STATION DEPTH "
STATE 'MANHOLE REFERENCE UPPER
REGISTRATION NO COUNTYLOWER
No I DESCRIPTION OF WORK FEE /� _
HOUSE SEWER CONNECTING TO 1 ,C / / C? rgo go
PUBLIC SEWER @ $14100 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR T CURB P L M L TO P L
PITS AND/OR DRAINFIELD 00
OVERFLOW SEEPAGE PIT DRAINFIELD
XTN CESSPOOL DRYWELL @ 00
HOUSE SEWER CONNECTING TO 1 P C NO
PRIVATE DISPOSAL SYSTEM 0 OD CO IMP NO JOB NO
N
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE TgINK PERMIT NO D PERMIT NO O
SEW E0. @ 00
V
ALTER REPASP SAL SYNTEN HOUSE 00 STATE ENCROACHMENT
SEWER OR PERMIT NO 0 O
INDUSTRIAL I:
WASTE AP AL
CHARGES P'W
OWNER s PERMCC $ 2 00 CONNECTION CHARGE FEE
AUTHORMATION1 TOTAL FEE OO REIMBURSEMENT IS DATE A CONTRACT WITH • FEE
n
HAVE
TO CONNECT THE ABOVEDESCRIBED EXISfHNAMED
NG DWELLING —APPROVALS DATE INSPECTOR f SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS OAY OF 1S_ -NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT BUILDINGORWORK -
ADDRESS SEPTIC TANK SEEP PIT(5)
AND/OR DRAINFIELD , 'I
I HEREBY ACKNOWLEDGE a THAT I HAVE READ THIS APPLICATION .
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL+n DRYWELL 1 1 C
WITH ALL COUNTY ORDINANCES AND STATE .LAWS REGULATING ALTER REPAIR SEWER OR �f
PLUMBING AND SEWERS
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/O
R
LICENSED AS RED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR T T 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER• '
DESCRIBED RESIO IAL PROPERTY BACKFILL SEPTIC TANKS ❑ '
SEEP PIT(S) ❑ TANK$CESSPOOLS_
SIGNATURE -
OF PERNITT
®. ALIDATION ROBERT A WOOD
' - 0A. Y 0 cnfR SUPERVISING MECHANICAL ENGINEER
i
- 06483:' MAR 111 0 D 5.00 Q
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