HomeMy Public PortalAbout5941 RENO AVE_Sewer__ SAS
808 8_d® APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BULLRING e; y
ADDRESS
JQIiN A. LAMBIE, County gine®r �.
CASSATT D. GRIFFIN. Supt of Building LOCALITY -.
FOR APPLICANT. TO FILL IN doss sr. :s-�
LEGAL
_DESCRIPTION LOT NO. -'` `^ g-7 _OWNERMAIL
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BLOCK TRACT ADDRESS �' V/
N0:OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
DISTRICT NO. GROUP ;7
BUILDINGS a.�L.(�-^��..�; BK MAP PROCESSED BY
CONTRACTOR 4 wt pr 3T
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ADDREss /G°• _ 4 €, _ CONNECTION DATA I
TEL.NO.
e � : DEPTH
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STATE MANHOLE REFERENCE � UPPER
REGISTRATION NO.1 '- f= - COUNTY } {}
NO. DESCRIPTION OF WORK FEE fay
A HOUSE SEWER CONNECTING TO
A PUBLIC SEWER C. $3 00 TYPEOF JEfrttN4�CTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. URB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3100 —
OVERFLOW SEEPAGE PIT, DRAINFIELD
E%TN., CESSPOOL.DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO "� P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $140 CO. IMP. NO. IF,_> JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER dal SI 0Q TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
5EVeER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE t—K f REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT EUI LDING OR WORK
ADDRESS - SEPTIC TANK,SEEP,FIT($) `
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM -
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
N CT PLUG AND
CALIFORNIA OR THAT I—AM THE LEGAL OWNER OF THE ABOVE ABANDON
HOUSSEWSTANKS (]
DESCRIBED RESIDENTIA PAOPERTY,, BACKFSEEP PITS)SEPTIC CESSPOOLS C
SIGNATURE —.
OF PERMITTE
VALIDATION ROBERT A. WOOD
CK ;° A.9. CASH SUPERVISING MECHANICAL,ENGINEER
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