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HomeMy Public PortalAbout5926 1/2 PRIMROSE AVE_Sewer__ 5 F-6@ i 65 19.65 APPLICATION FOR PERMIT Z &E•S DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAASL3IE, Cv^UN'i'Y ENGINEER ---ADDRESS - -- - -- .�.-----._._---..__---- CASSA'TL T E), GRIFFIN, SUPT OF.SUILDING _OCALI'fY FOR APPLICANT TO FILL IN doss ST [REGISTRATION EGAL :.-- SCRIPTION LOT NO, OWNER MAI L OCK TRACT NO.GF BLDGS, Ci'CYTEL. N0.E OF.LOT - NOW ON LOTE OFDISTRICT NO, GROUP I MAP [LllINOS BK PG NTRACTORCOIdIAI£C I®N DATSTATION _ DEPTHYTEL h --------— UPPERMANHOLEERENCE STAi E LOW.F.R NO. ❑ C NTY N0. ! DESCRIPTION OF WORK FEE ---- ---.. -_ -._ - - - ------ TYPE OF CON 'CT§ON� LENGT. ..ROM .. HOUSES TVtP CwR'mcTING TO �� v j PLBL1CfiEv4. R $3,50 - CURB P.L. M-,L. A L. SEPTIC T NF SEEPACE PIT OR - ___ PITS AND/OR R�.7PA1NriELD ii' $3.40 _--.---__— --_ —. __--__—_-- OVERFLOW SEEPAGE PIT..DRAINFFELD i i P C N0, _---_I- EXTN_,CL SPOOL,,"RYWELL,M._N_H.QLE C—$.2_04.1.—_--�'—_-- CO, IMP. N6, _JOB.iVO. I HOUSE SEWER CONNECTING TO '--�T—.—~.-- --- --"--_—.—----..—._- _- __;'- PRIVATE DISPOSAL SY TEAT �t $1.60 I TRUNK PERMIT N:Q _ AD PERMIT N0, CONNECT ADDITIONAL B!DF OR ' I •-� STATE ENCR0'' M€"1�7 _�_ VlURk"I;C HOUSE SFY F' it S 1.04 PERMIT NO - ALTER,REPAIR OR ABANDON HOUSE i _- -- ;. SEWER OR D SPOSa SYSTEM /�: INRU�STI�NAL -- t ' ... s i_(74.l__—.. iVAST@ APPROVAL — -- � CHARGES CONNECTION CHARGE FEE OW'NER'S PERMIT 5 1, Op —} - REIMBURSEMENT FEE AUTHORIZATION - TOTAL-FEE-'— t� ;) -- -- IFiAVE AT THIS DATE A CONTRACT WITHTH.E HEREIN NAMED CON. APPROVALS I DATE INSPECTOR SSICAPTLRc TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING. DWELLING TO THE PUDLI SEWER. �^ 3 , NEW HOUSE SEVER r - — SIGNED HIS_ _ DAY QFC 19—:.>—` — CONNECT ADDITIONAL tr /// - OWNER OR ��'f BUILDING OR'NORK - OK'NFRS ACENT , fit, y,. ..---- -- ---- - ____I-.-----F. ---- -_. �i...— SEPTIC TANK,SEEP, PITS) ADDRESS y YJ _; -sa ! r AND/,0_RDRAINFSEID I j ' CESBP©OL CT DRYIM1'F,L.Lt,� I Y;ERE KY AC!,�NOW i.EDGE THAT I. HAVE READ HIS APPLICATION OLD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Wilii ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR PLUMBING AND SEVERS. _SEWAGE DISPOSAL SYSTEM � --�-------------- I HEREBY CERTIFY THAI i AM PROPERLY gkGTtTERED AND/OR. DISCON NEC` PLUGAND LICENSED AS REQUIRED P,'Y LOS ANCE;ES CfUNTY AND --- STATE Of A'gANDGNhG�.iSESEWE'R CALIFORNIA OR THAT,,,I AM THE LEGAL ,OWNER OF THE ABOVE -- - - EW---------.�-_------s----------__.__-- . . DESCRIBED RESIDENTIAL ROPER Y. ,-- BACKFILL SEPTIC TANKS SIGNATURE ' SEEP.PIT(s) v CESSPOOLS LI j OFPERMIU_�Em"y - - - - IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROB EFfT A.WOOD, CHIEF£L.BG. INSPECTOR cx. ;a. a. easx