HomeMy Public PortalAbout6316 PRIMROSE AVE_Sewer__ j�
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OA420 . APPLICATION FOR PERMIT.'
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DI`IISION BkJiLDlNG
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. TENSER, Supt of Building — -� — - --- - ---
LOCALITY
NEAREST - —CROSS -
FOR APPLICANT TO FILL IN 4�<s
----
LEGAL a
&::C R1 PT'fON LOTNOOWNER
MI All L
A'O•'-K TRACT `,. ADDRESS
NO. OF SLOGS,
SIZE Cr LOT NOW ON LOT CITY TEL., NO.
USE OF
BUILDINGS - D�51'R IC7 NO. GRO - hi,q?� PROC ES53 BY
CONTR ACI"OR
ADDRESS CONNECTION DATA
--
TCL NSTATION;' DEPTH t /
�'
TY ' O. y �.
CO USTA TNTY MANHOLE R FERFN(E
REU:ST RATION NO. .. i _.
No DESCRIPTION OF WOR3t` FEE -- --- ---
TYPE OF CONNECTION LENGTH FF��M
_- .CX
� HOUP.E 54_L�a'ER CO NN EC71i+IG 70 Y. -CURB p P L M.L 'r0 P �y/.• �.c
J PUBLIC SEWER " - 0
a $-;.00--,-- - . F.C.NO
1 SEPTIC TANK,SEEPAGE P47 OR - ----T
AND/OR DRAiNFIELO �2 $10,00 CO.?!AP NO.
PITS
-.— _CO _._.__ ---_ �_._.—..s—._____.�HOUSE SEWER' NNECTING TO '� TRUNK PEkM17 NO. ROAD PcRM17 fJ O. '
PRIVATE DISPOSAL SYSTEM $3.00 'hd
CONNECT..DDITIONAL BLDG. OP. ,
AFFIDAVIT � waly€x east Mtn � RECORD INSTR tV O, ', - DATE
WORK TO HOUSE SEWER @ $3.00
'I OVERFiOW SEEPAGE P17 GRAINFIELD
.�
EYTN,CE POO DRYWELL,MAN OLE� $5.00
_._
- A4 TER..RFPAIR 6R ABANDON HOUSE I HWY.OR ti(.WIDENING
SEWER OR DISPOSAL.SYSTEM $.3-_OO --_.___ _.-._.- -
__ . 5T4
STA TE EN.,ROACHME Ni'
PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVtTT ER PERMIT_ __ 2 00_ — --— --------- _
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE i z
! HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REi MMSURSEMENFEE--- -- - ---- -- -
THE ABOVE DESCRIBED EXISTING DWELLING --- -- --- -- -
7P:A C7sJP !'O CON-0 _./q-q/.7..T
O THE UBLI S,..Y�R APPROVALS 7 DATE iN PECTC iS:GNA URF.
SIGNED THIS DAY L7.� �— f3_. . ----' -------------- - --_._ -__— ._.---
O-WNER ORNEW HOUSE SEWER
OWNErt.i AGEN'TY,._-.__, CONNECT gDDiTi6NAL.
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP PIT(S) -.
I I1?FRFf"Y ACKNOWLEDGE'. THAT ! HAVE READ' THIS APPLICATION
ANDi OR DRAT NF'1 LLD
rtnA.;: THAT TliE A£JD __Vt5 CORRECT AND AGREETO COMPLY
4YlTH AL1. -COU NTYORDINANCES AND STATE LAWS REGULATING
PLUMBMNG AND SEW ERS CESSPOOL ❑ DRYWELL
I. HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS, REQUIRED BY LDS ANGLES COUNTY AND STATE OF SEWAGE.DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND 1'0
..
� _ DISCONNECT
N .,WAND
RES1LE N, THF ABOVE D c RiB D R51DGNTIgLPROPERTY. ABANDON HOUSE SER
SIGNATURE
OF SWM?i7EEBACKFILL SEPTIC CASKS
SEEP, _
- —_-_..-_----.-
...__
Piz(5) U _CESSPOOLS i
VALIDATION ROBERT A. WOOD
1-
SUPERVISING MECHANICAL MECHANICAL E.'NGINEER
M.O. CASH
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