HomeMy Public PortalAbout5703 PRIMROSE AVE_Sewer__ • �`xi
76868 3-E4
7EA642D APPLICATION 40R PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FU
NG
JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of BuildingTY ✓ .. l _
TFOOR'PPL CANT TO FI 1CROSS ST
LEGA .341
L ' t� J! Ylf^' -
DESCRIPTION LOT NO '
f �r
-Z __ __ _
BLOCK TRACT MAIL ADDRESS
NF LOGS,
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILD F .f / ! DISTRICT NO. GROUP MAP P�QCESSED BY
v BK PG '¢t \
CONT RA CTCyt ,� .J J '"
ADDRESS y.,,a-.";; .. CO NECTION ATA
/TEL. NO - ! _7 �� STATION DEPTH y
REGISTRATION NO. LJ COU NTV y,ANH REF SNE =' � Gil ,- LOWER
'~No. DESCRIPTION OF WORK FEE TYPE OF CO �i TIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y, URB', P,L, M.L,TO P.L.
PUBLIC SEWER $8.00 � � _ P.C.NO. }
SEPTIC TANK,SEEPAGE PIT OR +1RUNK
\/ JOB NO.PITS AND/OR DRAINFIELD $10,00HOUSE SEWER CONNECTING TO PERMIT NO. ROAD PERMIT NO. -/t% U
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL SLOG.OR ; AFFIDAVIT WAN[R [ASEM aNT RECORD. INSTR. NO. DATE
WORK TO HOUSE SEWER $3,00 ��
OVERFLOW SEEPAGE PIT,pRAINFIELD ' ,
EXTN.,CESSPOOL,DRYWELL,MANHOLE® $5.00
HWY.OR ST.WIDENING UJ
ALTER,REPAIR OR ABANDON HOUSE
STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM $3.00 V)
--- I PERMIT NO. _ Z
j INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $1 2 oo — -
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE --
'1HAVE AT THIS DATE A CONTRACT WIT4 THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DC ISED STING DWELLING
TO THE PUBLIAPPROVALS DATE Ir�_
C SE NSPECTOR'S 51GN�AT4UR
SIGNED THIS DAA' OFA 19
OWNER OR -- • +` s NEW HOUSE SEWER
OWNERS AGENT ' O
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS_ SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFt€LD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY --
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIREIf/fiY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT M THE;4EGAL OWNER OFeAN.E INTEND TO "-
RESIDE IN, THE AHO DESCR D R (DENT-AL RTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIGNATUREOF PERMITTEE y..+. <�`�� BACKFILL SEPTIC TANKS ❑
SEEP.PITS) ❑ CESSPOOL
VALIDATION. - ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. "CASH I/