HomeMy Public PortalAbout5832 PRIMROSE AVE_Sewer__ '6A -61
E�883 18.54 APPLICATION FOR PERMIT 1
- �&
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE 'DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER
ADDRESS
CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
LEGAL
DESCRIPTION LOT NO, OWNER
BLOCK TRACT MAIL
— ----.----�---- ADDRESS
NO. OF BL.OGS,
S}ZE OF LOT NOW ON LOT CITY Yt:t. NO. '
USE OF -
BUILDINGS DISTRICT NO. f GROUP a MAP
j BK PG
CONTRACTOR
ADDRESS — CONNECTION DATA
CITY TEL, NO, STATION DEPTH
0 STATE �� MANHOLE REFERENCE —
REGISTRATION NO. 0 COUNTY
^'---- — - -- — -- --' TYPE OF CON.NECTIO'.v LENGTH FROM NO. l� DESCRIPTION OF.WORK FEE K -t'} P.L.; M.L.TO'P-.L.
—� HOUSE 5 WER CONNECTING TO
PUBLIC_SEWER _ t`2. $ 3.50
HOUSE SEWER CONNECTING TOi �I4
Phl_VATE DISPOSAL SYSTEM 1 OO I �
CONNECT ADDITIONAL BLDG'. OR � CO. IMP,N0. JOB. NCb..
_ WORK TO HOUSE SEWER i.00 _
—i ALTER OR REPAIR EXISTING ---
SEWER CR.DISPOSAL SYSTEM - _ 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
WSCONNL TAND ABANDON SEWER �� STATE ENCROACHMENT
AND/OR DISPCSAL SYSTEM 1.09 ( _� —
- �--- _ - PERMIT N0.
SEPTIC TAN'S. SEEPAGE IT OR —
PITS AND/OR LRAINFIELD 2.00 _ INDUSTRIAL
CESSPOOL-DRYWLLL I�
WASTE.APPROVAL.
—� SPECIAL CONDITIONS ONLY 2.00 ! CHARGES
PEHI+�IT CONNECTION CHARGE FEE
AUTHORIZATION
__ � i t 1 00 --
AUTHORIZATION TOTAL FEE I�~,� REIMBURSEMENTFE'E
I HAVE THIS DATE CONTRACTED WITH THE HEPEIN NAMED CON- APPROVALS DATE .INSPECTOR'S SIGNATURE
_
TRACTOR TO CONNECT THE ABOVE DESCRISr.D EyI. tiNG DWFML(NG
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS_-_ DAY
OWNER OR CONNECT ADnITIONAL -
OWNERS AGENT��_1.�..�._ BUILDING OR S40RiC
SEPTIC TANK, SEEP, PIT(S)
_ANDJOR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL[] DRYWELL I�
AND S'1'AT.E THAT THE 0,61.NE IS CORRECT AND AGREE TO COMPLY --.WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM ANGELES
REGISTERED EKED AND;O.F DISCONNECT PLUG AND
LICENSED.AS REQUIRED BY LOS ANG.:LES COUN'['Y AND STAT'.. OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER.
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(-)
SEEP. PIT(S) F1 CESSPOOLS
SIGNATURE - -
OF PERMITTEE_____
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION
0 5 6. 3 EHEC 1 55 X11 to
BY BY
DEPUTY - DEPUTY
BY BY