HomeMy Public PortalAbout6008-6008 1/2 PRIMROSE AVE_Sewer__ 3=BS
' 6
5 a E-66`i APPLICATION FOR PERMIT
5 Fc E-
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,SUPT OF BUILDINGd
LOCALITY t_�"�.,___.�:..-• �"
FOR APPLICANT TO FILL IN `CROSS r
- CROSS ST.
LEGAL
DESCRIPTION LOT N0. '. ._ r OWNER
BLOCK TRACT / MAIL
_ADDRESS
NO OF BLDGS. -_�s—�_
_SIZE'OF LOT NOW ON LOT CITY �� -N ,~
__ ;��'.. �"�^� _.: TEL. N0.' 1
USE OF _
BUILDINGS �- DISTRICT NO. GROUP ( MAP
BK PG
CONTRACTOR_
ADDRESS 'a t` Iri.d -v L?,� _, -- — CONNECTION DATA
97
.. CITY �.`..�,._ TEL N0. i"'I ,,�, !' STATION DEPTH
STATE MANHOLE REFERENCE. --UPPER
' _ LOWER -
R£GtSTRA7-ION N0. 'py^ `.'' ! i; J' - y._
NO. DESCRIPTION OF WORK FEE --
!I HOUSE
SEWER CONNECTING TO YTYPE OF CONNECTION P M.L.CNGTH FROM —
PUBLIC SEWER _ s_3.50 Y. CUB v .L, .L. TO P.L.
HOUSE SEWER. CONNECTING TO
PRIVATE. D15POSAL SYSTEM 1.00_1 —
Tf
CONNECT ADDITIONAL BLDG.OR _ - — `—J--- J—? B N0.—� --- -
P
WORK TO HOUSE SF1^iER_ 1.00 +� ciCO. It7P N0, JOB NO.
I ALTER OR REPAIR -
_—_ I__SPVER CR DISPO_S L SYSTEM_ _ —_1.00 1 TRUNK PERMIT NO_--�_- ROAD PERMIT.NO.'_-".
^.)11 DISCONNECT AND ABANDON SEWER �— STATE ENCROACHMENT
IND/OR DISPOSAL SYSTEM IAO i PERMIT NO,
SEPTIC TANK,SEEPAGE PIT OR 1
--..._. .
PI1S ANO/QR DRAINFIELD x.00 j INDUSTRIAL
��� __ _ WASiZ APPROVAL
CESSPOOL CRYWvELL
SPECIAL CONDITIONS ONLY 2.00 f — CHARGES
CONNECTION CHARGE FEE
OVMER.S PERMIT $I i�- 00 -- — -- _
r
AUTHORIZATION TOTAL FEE --- REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NA?.-IED CON- _—��-
TRACTOR TO CONNECT THE ABOVE D'ESCR.IOED EXI ttNG DWELLING APPROVAL;_ _—_� DATE tNSPrCT0WS Sl; ATURZ
7'0 THE PUBLIC SEWER
NEW HOUSE SEWER
OWNER OR ---� CONNECT ADDITIONAL. —�
OWNERS AG£N �-. -' _BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS--.-" AND/OR GRAI'AFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVOC READ THIS APPLICATION CESSPOOL 0 DRYW'ELL Ll
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMPING AND SEWERS. SEWAGE DISPOSAL SYSTE,VI
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ""—
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL ghICR OF THE ABOVE _ ABANDON HQIJSE SEWER _
DESCRIBED RESIDENTIAL PROPERTY. �,"1 1. "1
BACKFILL SEPTIC TANKSC'.',
SEEP.PI":(5) LI CESSPOOLS[] -
SIGNATURE .�;.'.. ,*.'- .,� °. -Ir
OF PER
-
WILLIAM J.FOX.COUNTY ENGINEER' VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR