HomeMy Public PortalAbout5947 RENO AVE_Sewer__ Z
E808 5-155
6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES of
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A.LANIPM , County Engineer ADDRESS j
LO"
COLEMAN W. JENKIN'S,Sup't. of Building rNEAREST
LOCALITY
C 0 ST.
CROSS L
FOR APPLICANT TO FILL IN
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ADDRESS
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE
OF DISTRICT NO. G��U MAP PROCESSED BY
P
13K G
CONTRACT
x5
ADDR -
CONNECTION DATA
cl STATION DEPTH 7
LI CE SE LICENSE UPPER
No. y
C,A ss MANHOLE REFERENCE
NO. ESCRIPTfON OF WORK FEE
TYPE OF CONNECTION LENFROM—
M.
7 HOUSE EWER CONNECTING TO Y-/ CURB P.L. L.
I SSEWER 00 0/ a�
P.C.NO.
`PJB
SEPTICTANK,—S E If P A-6-E--Pl—T 0 R IMP.NO. JOB NO. CL
t�Tll-TS ANDOR DRAINFIELD $10.00 0
NE--— T-0 u
F—HOUSE EWER CON CTINii TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL, SYSTEM $ 3.00 -v
CONNECT ADD( IDNA E-BLD G-0-R--- AFFIDAVIT WAIVER EASEMENT CORD,INSTR.NO. DATE
WORK 10 HOUSE SEWER $ 3.00 0
-ATY'n,--R E-T-ATR-OR- 11 u
SEWER OR DISPOSAL SYSTEM $ 3.00 i
F E-ow-SrEPA TE-PTT—DRATNT= HWY.OR ST.WIDENING (L
EXTN.,CESSPOOL. MANH
CLE $ 5.001 -
STATE IENVCRO HMENT z
PERCOLATION TEST $ 5.001 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
IT
CHARGES
PERMIT sL 210�
Iy I CONNECTION CHARGE FEE
AUTHORIZATION 'AL FEE J" I
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
T R ACTO R To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
To THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS—DAY OF --19— J
OWNER OR NEW HOUSE SEWER
OWNERS AGIENT---
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS-----
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO/OR DRAINFIELD
AND
STATE THAT THE
E ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING
B ING AND SEWERS. CESSPOOL [I DRYWELL ❑
I HEREBY CERTIFY TH I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED ' REQUIR BYfLOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA
A OR THA AM/lHE7.LEGAL 414 INTEND TO DISCONNECT PLUG AND
ER -7 '
0TIAL4CIPER' ABANDON HOUSE SEWER
SIGNATURE
RESIDE IN. THE A E SCRIBED
R�g
BACKFILL SEPTIC TANKS El
OF PERK EE I , --- CPT
PIT(5) ❑ CESSPOOLS ❑
VALIDATION'-
CK. M.O. (,CArH3s J
_,
0-
i 2 6 D