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HomeMy Public PortalAbout5944 PRIMROSE AVE_Sewer__ 6A642D OR° �� A6S2APPLICATION FPERMIT Ai COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 999LLLA9t9tY DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer aDDRE s �y ae I Y WILLIAM A. IEN'SEN. Sup't of Building y+ _ Local.Tt ,tj9_f hE REST FOR APPLICANT TO FILL IN ROSS 9T LE AL DESIR PTION LOT NO L OWNER ' �'�" '�'-_ ",z�. �" _ - _.-_ � MALL BLOCK IRA_—T ADDRESS NO. OF BLDGS. _SIZE OF L-OT NOW ON LOT. CITY "Y--.: '� C'/� -EL. NO. USE OF � ._ �.__ BUILDINGS DISTRICT hi o. GROUP MAI Yft _E55cD 9Y CONTRACTOR +, +-._ tF-i ..=-i f'_-•sEZ+' f' /�"-�..� Bi( PG _ - ADDRESS : E'-d '' CONNECTION DATA -.IT'�- dZ G'rt ✓ TEL NO. +,- aye ,STATION DEPTH STATE MANHOLE REFERENCE e REGISTRATION O.�r �.r J ,!' L,; COUNTY NO. C_ESCRIPT(O1N OF WORK FEE TYPE OF CONNECTION LENGTH FROM OJ ES�'6NER CON N'c GTI PdG TO Y____...__CURB P,[�_ _--M..L,TO P.L. PUBLIC SEWER _ @ $5.00 5[:P IC?A.1h SEEPAGE PiT OR i P.C.NO, CO. IMP.NO. JOB NO "1 PFI'S Z40/OR DRAINFIELD @ $10.00 ! - ,d 110 5_:SEWER CCNNF.'T{NG'YO ---- - TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM @ $3.00 ___ ___ rep , ONNECT ADE'TICNAL BLOC OR -- ---- �-- -�- AF'FIDAViT wF[Y£R i45£M£NT REE ORD.INSTR NO I DATE i —T WORK TC HOUSE SfWEri OVERFLOW SEEPAGE+SIT DRAIN FIELD EXTN CE 5p OL.DR ELyMANHOLE @ $5-00 --{---._ HWY. OR SY W4r DENING ell ALTZR'- Ae#DR SANOO _ Z` W F_R O h D �^aSA -$1.00 - _ .__-._ __._ .._ ._—_.. —_ ._- -__ --. STATE ENCRPACHMtNT --,. _— PERMIT NO. WASTE APPROVAL CHARGES �INERVV 'S 4PERMIT �! rJ0 - - - ----- ----- - �+ NE - ----------------- ---- AV�qHORIZATION TOTAL FEE - CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THC' HEREIN NAMED CON- REIMBU R5E MENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTI. DWELL.iNG --- - ----y--�--'-�- -----'- TO THE PUBLIC -WER. APPROVALS DATE S INSPECTOR-S SIGNATURE SIGNED THIS -- DAY OF.._�^s__ --�. OWNEh.OR y NEIV HOUSE 5EVYER OW!d RS 4Eh CONNECT ADDITIONAL BUILDING OR -WORK .� � F- SJ,�d'A !'(,,fC�_�731 AYS Ga'•�X�� _ _WORK - -- SEPTIC TANK BEEP PIT(S) HE iFBf At tC M11 OWLED E PHA I CLAVE RERD-7H75 APpLICAT(ON AND,OR D3RA[NFIELD — - AND STATE THAT THE ABOVE 1 S CORRECT AND AGREE TO COMPLY ---- ---- ----- —t-- -----'-- WIT1-^ ALL SOU NT'x' CRO[PdPoNC ES AND STAT[ LAS REGULATING _ PL'JM8.,"iG AND SEWERS. CESSPOOL ❑ DRYW ELL ❑ Ii HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS P Q1 tRED 9Y LO ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL S--S"EM C.ALIFGRN IA OR AT I AM THE LEGAL OWNE )AND INTEND TO ----- -- - � I RESIDEItd; TIi E. A OVE DE.:CRf>3E, RES%DEN AL H0 ERTY DI S't:'ON NEC. PLU AND _ ABANDON*LOUSE SEWER SIGNATURE N _ OF AUR tTTF I,, BACKFILL SEPTIC:TANKS. ❑ 1 SEEP PIT:(S) CESSPOOLS ❑I VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH >1 S 4: