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HomeMy Public PortalAbout5740 PRIMROSE AVE_Sewer__ 78APPLICATION GA42D 1"'i / -.. ■ � IT 7 i?z E.Ff9.9.55 DIVISION OF BUILDING AND SAFETY �EWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles F_jA� TryS.;f�i;P.1 A. LAMI'3ia�, COUNTY �,Iot;�1EE2CASS.ATT'D. GRVFFIhI,'SUfi'T CF BUILDINGFOR APPLICANT TO FILL IN N ;ss 5fT LEGAL f' - D:.SCRIPTION LOI' NO O+t.''d R to ---- - TAA,T -I BLOCK TRACTAJOkF s NO,OF BLDGS. SIZ-E!OF LOT I ✓ ": 1 j NOW ON LOT CITY ? TEL. NO. - USF,OF i ^9 i`_ r DISTRICT NO, GROUP MAP BU)LDINinS _yl S" _ i _._. _ BK kC j ADDRESS :. .— �DNTaAcroR` CONNECTION DCPA _ ----- - - - bja. $):A71®N CITY TEL NO. ,, 1 --- -- .✓ PTH _._. _ �.` .— MANHOLE REFERENCE C STATE R;rGTSTRATJON F40 - ❑ COUNTY NO. l DESCRIPTION OF !v0 K FEE — -- -- --- -- -- ''-� - --.. -- --'— -- —` -- --- TYPE OFiCT30N LENGTH FROM t. HCUSE SEWER CONNECTING TO C ,�.• ye C�"s P 1. M L.TO P L. _ »� ._ PUBLIC SEWER - @ $3.5� I .1 ...-- ---....'�.•.-'->`_--- i _._. _... - _-_ -- --- - .-- ------ - SEPTIC TANK SEEPAGE Pt7'OR _ P1TS AND/OR.DRAINFIELO r> $3,00 OVERFLOW SEEPAGE PIT,DRAINrIELU I4 + P C. NO. i EXTN„CESSPOOL,DRYWELL HIANH0LE 0 4- Co. 1dP N0. 2.00 —.I — HOUSE SEWER L"ONNEC(INP TO ,•` PRIVATE DISPOSAL SYSTEM ca, I ( TRUNK PERMIT NO ROAD PERMIT_ IiO..' CONNECTADDITIONALBLDC.OR � WORK TD HOUSE.5ELVER !i. 1,G,0 STATE ENCROACHM NT f $ ';.__..--- .._PERMIT NO. I _ _ ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL,SYSTEM 57E INDUSTRIAL CHA El,' (t{ _..._ -__- 9.0 C _. -- _ _-_ WASTE APPROVAL R CONNECTION CHARCE FEF. OWNER'S PERMIT -- - _—.__- . - --- - -T-._----_.._.._----- RE !4BURSEMENT FEE - AUTHORIZATION TOTAL �EE �_ - �n I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS ALS DATE �INSPECTgR'SSIGiNATURE TRACTOR TO CONNECT” THE ABOVE DESCRIBED EXISTING DWELLING � TO )HE PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS Y DAY OF --�IDCONNECT _ - CC _ ADDITIONAL � --- -__-_ 6VdN£R. DR NNFCT" F' _ 1' ) BUILDING OR WORK OWNERS ABET Sy-,,-,TIC NK SEEP -_.. ADDRESS_. AF"D/OrR DRAIN FIEL3'i- I HERERE AND BY ACKNOWLEDGE THAT I HAVE REAM) THIS APPLICATION CF_SSPOCL[]' DRYWELf.i..:i 7E THAT II4E ABOVE IS CORRECT AND AGREE TO COMPLY _ .. WITH ALL COUNI"Y ORDINANCES AND STATE LAWS REGULATING A't.TER,REPAIR SEWER OR. 'I PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM I 1 HEREBY CERTIFY THAI I AM PROPERLY REGISTERED AND/OR PLUG PL&iSCONNDISCONNECTPsAND. - —_- --`-_-- LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND SPATE OF ABANDON HO SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY, •) BACKFILL L SEP.IC.TANKS D SIGNATURE SEP 17(.5) ; 1 CESSPOOLS OF' PERMITTEE — —� IOHN A. LAMBIE, COUNTY ENGINEEF2 VALIDAT'IMI-„,k ROBER-(' A. WOOD,CHIEF PL_EIG, INSPECTOR Cfi, M.O. r'CASH e� 51w r j