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HomeMy Public PortalAbout5709 PRIMROSE AVE_Sewer__ 7CA64213 APPLICATIONE4;63 -. F�O R PERMIT". 1 5&E63 12.54 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D I S POSA L Deportment of County Engineer r County of Los ,Angeles BUILDING `FhtM.J. FOX, COUNTY ENGINEER AD REESs CASSATT LJ. GRIFFIN, SUPT OF BUILDII,G LOCALITY �FOR APPLICANT TO FILL IN c Ass sr. LEGAL -�..�..._ DESCRIPTION .LOT NOOWNER -- _ BLOCK TRACT 'r ,y MAIL ADDRESS �-- N0.OF BLDG i SIZE OF LOT t - •�+"3.. NOW ON LOT _ - CITY -`. -- -•4-""'-- ---_.__-._ e",.._ TEL. NQ.'/', / USE OF BUILDINGS f a''a ✓ i _ DISTRICT NO. GROUP MAP 13K PC CONTRACTOR 'Xi i ADDRESS lWC3I+I2v'Et:�`dt7'd'd DATA CITY ,�* .' •> !' +%.` ^Y�;`.v.,ry <.,,a TEL. NO, 95 .y' P' i-- _STATION.._._- _.----.-- DEPTH �. ❑ STATE ;.ANHOLEREFERENCE REGISTRATION NO. ''aril �, .�' --(I'-�COUNTY _...__ Uf�r+i�t� LOWER_ ..R_ '-'—' - I",O� CONNECTiON LENGTH FROM _ NQ. DESCRIPTION OF WORK FEE cUR9 Phi M.L.'TO P L..d.__ HOUSE SEWER CONNECTING TO PUELIC SEVER $ 3.50 - -if--I FOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSIEIA 1.00. - CONNECT ADDITIONAL BLDG. OR CO. IMP, N0. JOB. NO. W ORK TO HOUSE SEWED_ 1,C0 I I ALTER OR REPAIR EXISTING -_j - �� SEWER ORDISPOSAL SYSrEM _ 1.0© -_ -.- TRUNK PERMIT NO. ROAD PERMIT NO. _ DISCONNECT AND ABANDON SEWER I STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 _-, _ PERMIT NO. SEPTIC TANK SEEPRBL PIT OR - "-- �"`""'-" _ PITS ANDOR DRAINFi EELO 2.00 I INDUSTRIAL CESSPOOL- DRYWELL — j A— 'WASTE APPROVAL SPI•CIA-L CONDITIONS ONLY 2.00 { - CHARGES I ---- -- - —�- _ CONNECTION CHARGE FEE OWNWS PEntI1 $ 1i 00 AUTHORIZATION TOTAL FEE y REIMBURSEMENT FEE _ - - I HAVE THIS DATE- CONTRACTED WITH THE HEREINNAMED CON- APPROVALS DATE 1!;SHEGTOP,'S SIGNATURE TRACTOR TO CONNECT THE ABOVE-DESCRIBED EXISTING DWELLING 1'0 THE PUBLIC SEWER SIGNED tHIS DAY OF._/ 1 "" 15.E = NEW HOUSE sEVER CONNECT ADDITIONAL OWNER O OWNERS ARZNT %' '^` -•:'Sr^_,..3..i� 3 r'. �.' -�- __BUILDING OR WORK_—__ ADDR . _ SEPTIC TANK, SEEP, PITS) _.____--_ AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDiN,ANCES AND STATE LAWS REGULATING. ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGIS'IEREO AND/OR -�_ -._..._ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT L AM THE LEGAL OWNER OF THE ABOVE ABANDON HQUSE SEWER DESCRIBED RESIDENIA�AL PROPERTY. BACKFILL SEPTIC TANKS[] . .SEEP. PIT(S) E] CESSPOOLS 0 - SIGNATUREOF PERMITTEE t=e WILLIAM S. FOX, COUNTY ENGINEER VALIDATION BY i.kCj 8 3 7 u MAR2 2 4 4.50 BY DEPUTY DEPUTY BY BY ,d DEPUTY . DEPUTY