HomeMy Public PortalAbout4837 PERSIMMON AVE_Sewer__ Ba
CE Boa•i.6 ak5 APPLICATION FOR PERMIT
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COUNT` OF LOS ANGELES SEINER-SEWAGE DISPOSAL
DEIPARTMIENT OF COUNTY ENGINEER
BUILDING rx),ND SAFETY DMSION BUILDING. r �
ADDRESS ` K" ,
jo-'11# t LAMBI£ County Engineer -
CASSt3Th'Da .R117FIN-. Sup'I a4 Building LOCALITY �� Ak✓( � o�� �� ��J,� r
NEAREST /
FOR APPLICANT TO FIU 1N CROSS ST.
LEGAL - k
DESCRIPTION LOT NO -�.�. OWNERy;Y
BLOCK TRACT
_ d ADDRESS �..�,: a �:��' i
y r NO.OF BLDGS. y
SI7E OF LOT t d ';ji,P,y�w- NOW ONLOT - r'�,./'s
CITY r 'a=.m. TEL.NO. d
USE OF
BUILDINGS - ,� e Via. DISTRICT NO. GROUP' BIC PG MAP F"CESSp$;Y
CONTRACTOR + -.� �. ✓;j
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ADDRESS CONNECTION DATA
CITY TEL. NO. STATION '* � ='r r'', DEPTH
❑ STATE FERENCE $
REGISTRATION NO. [] COUNTY MANHOLE REPPERe�
NO. 1 �DESORIPTION OP WORK FEE ►=°'--� —' = =�
r
HOUSE SEWER CONNECTING TO
PUBLIC SEWER _ @ $3.00 � P
SEPTIC TANK,SEEPAGE PIT OR. V TYPE OF CONNECTION- ';� LENGTH FROM + �
PITS AND/OR DRAINFIEL'0 $3.00 Y CURB � P L Jr M L..TO P L.
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.,CFSSPOOL,OR INELL,MANHOLE `. $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0.
CONNECT ADDITIONAL,BLDG.OR. � TRUNK PERMIT NO. ROAD PERMIT'NO. $
WORK TO HOt7SE SEWER @ $I.00
fALTER, REPAIR OR ABANDON HOUSE a STATE ENCROACHMENT
5EWER OR DISPOSAL SYSTEM
�' $1,00 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERM 00 .ONNF Ct TON CHARGE FEE
AUTHORIZATION TOTAL FEE w � REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. API�BOVALS DATE I INSPECTOR`S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. -- - -
SIGNED 'THIS DAY OF i9— NEW HOUSE SEWER --
OWNER OR CONNECT
ONNE T ADDITIONAL
OWNERS AGENT OR
SEPTICTANK,SEEP, PIT(S)
ADDRESS _ .- _ AND/OR DPAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Iq
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL Q 1
WITH: ALL COUNTY ORDINANCES AND STATE: LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AN" 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 THE ABOVE --- ---_----
DESCRIBED RESIDE`tT'Ai PROs_'t:3TY, BACKFILL SEPTIC TANKS C7 r
_
SIGNATURE SEEP. PITS) Q CESSPOOL,syDJ
-: -.__. ,..._�,_
OF PERMIT74E m,:,.
er VAI.IDATI04-- POSL-I T A.WOOD_-,'
CA", m.o. ~cmm Iy �nor m RIEC IAkilr-.AL,ENMINEER
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