HomeMy Public PortalAbout6319 PRIMROSE AVE_Sewer__ 76Ae4 Q APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION [ADD
UILDING 3 r
JOHN A. LAMBIE, County Engineer REWILLIAM A. JENSEN, Supof Building
OCAL Tv
`NEAREST
CROSS ST
FOR APPLICANT TO FILL IN - -
-- -
DESCRIPTfON LOT NO. d OWNER3�.�s
y y
MAIL
BLOCK TRACT ADDRESS
No. OF SLDGS,
SIZE OF 'LOT NOW ON LOT CITY TEL. NO.
USF OF y
BUILDINGS ''y DISTRI_T NQ t3NQI)[" Ni is BY
CG NTFACTOitq"�r j... I
L - y "
y -
AODRE s ' �'✓, R # CONNECTION DATA
�V'y r: > _..._- STATION 1�k _
CITY S t, 4'4�rJ'r/v,q> a _ TEL O,_{6 ` t" O£P7fi
'- COUNTY STATE MANHOLE REFERENCE ,ryj f_. �y-� -- d+� UPPER;
REG.1 TRA IO.N NO. _ .__ �, )'^ .ii _ - .s
. — - ._1e .__ _ ___ ___ _ S
NO. ESCRIPTI N OF WORK EE TYPE OFCONNECTION LF NGTS PRO �
-...y ._— >
P t,CUS_ Lw_
W R CONNIE TO I ,r£"" �'. CURB P L M.L.TO P.L,
PUBLIC SEWER $S.GQ --
- — -
P N
py
--r SEPTIC TANK.SEE AGE P.IT R I I
FIT'S AND/OR DRAINFIELD ' $70.OG CoMP N9. _
MOUSE.SEWER CONNECTING 0
TO TRUNK PERMIT NO. ROAD PERMIT NO. P"1
PRIVATE.DISPOSAL 5Y TEM Q $3.00
-
Ct NNE..:T ADOITIONA� BLDG OR � AFFIDAVIT we?veR EASEMF�'t I REC 6H D. LN`iTR NO, � DA7E
_..WORK TO HOUSE SEWER CFC $3.00 I !
-—. -- _.—
OD
dERmLOWSE PAGE PIT,DRAINFIEti.D
IEXTN (CE SPOOL,DRYWELI_,MANHOL_E@ $5.0G
I
—__ SHWY, OR ST.WIDENING z
I A;TER,REPAIR OR ABANDON}.OUE
.EWER OR DISPOSAL SYSTEM Q $3.fl0 - _--_____ __.____._..._____-.____.___-_.___._.___�.- ..____�. ..
_y __—__— _.. , �_ STATE.EIICF20ACHMENT
{ PERMIT NO.
__._.—_—_---_____.
INDU5TR('AL
T
WASTE APPROVAL
PERMIT_
�WNR' IT
---
AUTHORIZATION TOTAL FEE y� CONNECTION CHARGE FEE
I HAVE AT 'THIS DATE A CONTRACT WITH THE HEREIN NAMED CION- R.EIhMBURSEMENT FEE
T R.:ACTOR TO CO lNECT THE ABOVE DESCRIBED EXIST�NG DWELL LNG ---- ---- - ----.--------.�__�--._- —_.-__
TO 7FiE FURL C SEWER. APPROVALS ALS DATE INSPECTORS SiGNATURr
SIGNED THIS_ --,DAY OF_._�-- �9 ------------
OWNER
_— —bW'NzR OR - 3 NEW HOUSE SEWER
OWNERS.AGE.NT `�
CONNECT ADDITIONAL j 1
BUILDING OR WORK
ADDRESS.___.__..—._____._`___ _—_—__-__
SEPYIC TANK.SPEP,p
PITS) T'
1 HEREBY ACKNOWLEDU THAT I HAVE. READ THIS APPLICATION ! i
AND/OR DRA!NY=1EL
AND TATE. TI-+A THE ABOVE IS CORRECT AND AGREE TO COMPLY
1
WIT I1ALL COUNTY ORDINANCES AND STAT£ LAWS REGULATING 1 f
PLUMBING AND SEWERS'.. - CESSPOOL. 0 DRYWELL C
6 HEREBY CFPT FY THAI I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR f3
t�I CE LASED AS REQUIRED BY LOS ANGLES. COUNTY AND STATE OF' SEWAGE DISPOSAL SYSTEM
C�A'II'ORN IA OR GHAT i AM THE LEGAL OWNER OF, AND iNTENO TO DISCONNECT PLUG AND
R
ES f DE !N, THE A,.iOV DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE _ -.._..
b1- PCRMITTEE.01,� ,,t'•u -.. -- ^^— - - -,-_,- BACKFILL SEPTIC TANKS
SEEP,PITS) ❑ CESSPOOLS ❑�
t VALIDATION ROBERT A. WOOD
}.�
CK'.� M.OCASH SUPERVISING MECHANICAL ENGINEF_R
S .