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HomeMy Public PortalAbout5949-5951 PRIMROSE AVE_Sewer__ assoa-a APPLICATION FOR PERMIT 1 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ` ADDRESS JOHN A. LAMBIE, County Hnginoer CASSATT D. GRIFFIN.Supt of Building LOCALITY NEAREST ' FOR APPLICANT TO FILL IN CROSS ST, LEGAL a . . . DESCRIPTION LOT N0. OWNER �, £ BLOCK TRACT r y� J"-" / MAIL ADDRESS NO.OF BLDGS. SITE OF LOT NOW ON LOT CITY TEL.NO. USE OF BUILDINGS Y� _1r s a l � _.` DISTRICT NO. GROUP MAP PROCESSED BY,. —�—� BK PG 9v CONTPA OR e_r. ADDRESS CONNECTION DATA r— ; CITY _ iEL N0,_ -- STATION ' DEPTH -14, STATE MANHOLE REFERENCE gP REGISTRATION Na. COUNTY ; +3 9 NO. DESCRIPTION OF WORK FEE " E SEWER CONNECTING T6 Al" / . PUBLIC SP.WER @ $3.00 HOUS — r'� �"..:�'- `b+ SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH fRM ITS AND/OR DRAINFIELD @ $8.00 Y. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PITDRAINFIELD £XTN..CE5SPOOL,DRYWELL,MANHOLE @ $2.00 , HOUSE SEWER CONNECTING TOP.C.NO. PRI VAT£DISPOSAL SYSTEM $1.00 CO.IMP.NO. �`^~ JOB N0. T CONNECT ADDITIONAL BLDG.OR @ $I 00 TRUNK PERMIT H0. ROAD PERMIT NO. WORK TO HOUSE SEWER AL''ER ,REPAIR OR ABANDON HOUSE vSTATE ENCROACHMENT' SEWER OR DISPOSAL SYSTEM a $1.00 PERMIT NO. INDUSTRIAL {` WASTE APPROVAL I CHARGES OWNEws PERS 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THF, ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS .DAY OF lgr NEW HOUSE SEWER OWNER OR f; CONNECT ADDITIONAL OWNERS AGENT-4' 4b�`' BUILDING OR WORK SEPTIC TANK,SEEP,PIT($) ADDRESS._ ANDJOR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL© DRYWELL El WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED REST EI$TIAL PROPERTY. BACKFILL SEPTIC TANKS[I SIGNATURE ) �I SEEP,PIT(S) CESSPOOLS El OF PERMITTELr b �► NAIMATION (ROBERT A.WOOD cK.,,r, M.R., GAsk SUPERVISING MECHANICAL ENGINEER