HomeMy Public PortalAbout6022 PRIMROSE AVE_Sewer__ 8A88
e5088 8.58 APPLICATION FOR PERMIT
7
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHNA. LAMBIE, CountyEu ADDRESS Hasa _� --"-"---`
CASSATT D. GRIFFIN, Sup t of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT Nb. - '� OWNER
BLOCK TRACT MAIL
_ ADDRESS
N0.OF BLDGS.
SIDE OF LOT NOW ON LO• CITY TEL. NO.
USE OF ' - — � -
SUILDINGS -- - DISTRICT N0: GROUP MAP FROCESSED BY
_._--- ---� BK PU
CONTRACTOR --"
ADDRESSCONNECTION DATA n`
CITY TEL 11:?, STATION DEPTH
STATE MANHOLE.REFERENCE �z _ � : UPPER
REGISTRAT30N N0. `- �_. - rte.. '1 COUNTY LOWER
NO. DESCRIPTION OF WORKFEE - -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF-CDN,NF T10N LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y• ;-`CURB P.L. M.L.TO P.L. Ff
PITSAND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT', DRAINFIELD
EXTN,.CESSPOOL, DRYWEI_L @ $2.00 --
HOUSE SEWER CONNECTING TO ' IMP. N0. - j t JOB N O.
C1
PRIVATE DISPOSAL SYSTEM @ $1.00 _
qIr_ONNEC'T ADllt7'lONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO .r
WORK TO HOUSE SEWER @ $1,00 _ ,e
ALTER,REIAIR.O.R ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT 5 2 Q0 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE _' ;' REIMBURSEMENT FEE
I HAVE. AT THIS DATE A CONTRACT W17'H THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS f DATE f INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER, �p
SIGNED THIS.____.__ DAY OF —i9—, NEW HOUSE SEWER
OWNER OR .-. CONNECT ADDITIONAL
- --_- _.
OWNERS AGENT__,,..._ - BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PITS)
-- — =_- - - AND/OR DRAINFIELD
I HEREBY' ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO .CGMPLY CESSPOOL 0 ORYWELL []
WITH ALL COUNTY ORDINANCES AND STATE LAWS..,REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT.I AM PROPERLY REGISTERED AND/OR. DISCONNECT PLUG AND
LICENSED AS REQUIRrO'BY LOS ANGELES COUNTY AND,STATE OF AP.ANDOtJ HOUSE SEWER
CALIFORNIA OR THAT F AM 'THE LEGAL OWNER OF THE ABOVE -
DESCRIBED RESIOENTIAj.' PROPERTY. - ;' BACKFILL SEPTIC TANKS ❑
SIGNATURE - , i _i SEEP.PIT($) �] CESSPOOLS 'r
OF PERMfTTEE-- _ i'.,y i .,.> - -
>F �X VATIDATICDM Y SUPERVISING
A. WOOD
MECHANICAL ENGINEER
I F'