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Home My Public Portal About6322 PRIMROSE AVE_Sewer__ ;6364 76A642 3 D P"-62 PPLICA ION FOR PER,MIIt 411 COUNDEPARTMENT OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BU,LDIN r> "OHN A. LkSMBIE. County Engineer ADDRESS J. WILLIAM A. JENSEN, Sup'4 of Building LOCALITY �_a'...-'Yw.;-o..,P .L NLA.REST FOR APPLICANT TO FILL IN t Ross ST LEGAL - DESCRIPTION LOT NO w-�qy 7y OWNER ��j.:y„4 � .;,-. S.- -�* ( MAIL \'acrsj 8 ALO.CK 7'RAGT A.QDRE'.55 NO- OF BLDGS. -SIZE OF LOT NOW ON LOT C11Y TEL. NO. USE OF BUILDINGS f DISTRICT NO. GROUPI_ PROCE'.SSED BY CONTRACTOR ADDRESS z✓��.; � - CONNECTION DATA - = - - --- - - - ---- ---- p - - - CITY N© /tea STATION DEPTH— STATEMANHOLE REFERENCE REGISTRATION NO. _ _ C.OUNTY - NO. t DESCRIPTION OF WOE'?K _, FEE €CONNECTION, --- LENGTH FitO -- ---_ _- -- -' -- -'— -- TY , P6 C ..., C HOUSE SEWER CONNECTING TO ::-% � n Y. CURB P I. % M L TO{P � A___j PUBLIC,SEWER S5 00 a D ---- ---- - --' - — - -- / / i SEPTIC TANK SEEPAGE PC.N`O PIT OR PITS AND/OR DRAINF IELD @ ;10.00 CO_ IMP NO 1 HOLISFSFW LR CON NCC i'NC-TO TRUNK PERMIT NO ROAD PERMIT NO. PRIVATE DI POSAL SYSTEM @ 53.00 BLDG OR AFFIDAVIT j WAIVER EASEMENT ( ONNECT ADDiY!ONAL I RECORD.INS7R NO. ! DATE WORK TO HOUSE SEWER $3.00 � 7 : EXTN.CESSPOOL,DRYWFLL,MANHOLE @ S3.00 - -_-_.i --- ALTER,REPAIR OR ABA NDON MOUSE- - .--- -_ ---�---- HWY. OR ST,WIDENING SEWtR OR D75Pc]SAL SYS,.EM Q --___- _-_C--._.__.___. _._-_.__-__ .. $_3.60 STATE N C.ROAHMENT PERMIT NO. INDUSTRIAL I WASTE APPROVAL CHARGES OWNER'S PERMIT z 00 --- — -- ----`---------- ---- V ES1tJRIZATIOlY TOTAL FEE CONNECTION CHARGE FEE A d I HAVE AT THIS DATE A CONTRACT `N'7H THE HEREIN NAMED CON- REIMBURSEMENT FEE -TRACTOR I'O N£CT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PU'€3'!Ir SEWER. APPROVALS ALS DATE j iNSPECTORS 67GNATURE SIGNED THIS._ ._DAY OF'___.. OWNER OR ! NEW HOUSE SEWER 4 , —- -- OWNERS A�:ENT "_ w — CONNECT ADDITIONAL BUILDING OR WORK ADDRESS -- -� -- - CPf IC TANK,SEE. IT(S3 i HERESY ACKNOWLEDGE THAI' I HAVE READ THIS APPLICATION `OR DfiA,1='1k:i,D ANO STATE. THAT THE ABOVE IS ,CORRECT AND Ac ._E TO +,OMPi.Y WITALL COUNTY ORDINANCES .AND 5?ATE:: LAWS RE.GULA.TiNG FLU MSING AND SEW rRS. CESSPOOL RYWELL HEREBY -CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR L.LENSED A5 REQUIRi=D L^Y ,'L.OS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM LA:LIFORNIA OR THAT I A*M THE LEGAL, OWNER OF, AND INTEND TO P OFbE !N, 'Th1E ASO DIS>;•:ON IECT PL LIC AND t I .0 F PESCR:IBrD ESYDENTIAL P OPER?V. fS ! ABANDON HOUSE SEWER SIGNATURE PERMITTEE SA`.KFILL SEPT'C TANKS ❑ Sr P!T(5) p CESSPOOLS VALIDATION ROBERT A. WOOD Crf M.O. CASH SUPERVISING MECHANICAL. ENGINEER � .