HomeMy Public PortalAbout6038 RENO AVE_Sewer__ 76A642D 3-ea APPLICATION FOR PERMIT
76A64
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FSS
LDING fJ
JOHN A. LAMBIE, County Engineer RE5sWILLIAM A. IENSEN, Supt of Building REST �_FOR APPLICANT TO FILL IN sT. _
_— LEGAL _— _.__.__
DESCRIPTION LOT NO y✓ , �/! ---�— OWNER
MAIL
BLOCK TRACT +' ADDRESS '�`
NO. OF BLOCS. k'
SIZE OF LOT NOW ON LOT CITY TEL, NO.
USE OF
BUILDINGS DISTRICT NO, GROUP MAP PROCFS$ED BY
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CONTRACTOR ,.....+^ (r ,(j'yi..G'�'�L/ Ai ✓'6 `y.; +
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ADDRESS CONNECTION DATA
CITY TEL. NO. STATION DEPTH -
STATE UPPER
1�+I MANHOLE REFER E
REGISTRATION NOI Lj COUNTY �'`� LOWER
NO _ DESCRIPTION OF WORK FEE _ TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P,L`."� M.L.TO P.L.
f'I PUBLIC SEWER $9.00 9 --
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $10.00 I CO.IMP,NO. JOB d.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N
PRIVATE DISPOSAL SYSTEM $3.00
-NNECT ADDITIONAL BLDG,OR a/s q. "^, AFFIDAVi—T rW6lV!„¢ t�SCMENT RECORD,INSTR NO DA LL
WORK TO HOUSE SEWER $3,00
OVERFLOW SEEPAGE PIT,L.MANHOLE T�'� �.` ;.EX7N„CESSPOOL,DRYWELL,MANHOLE 55.00 C `:v
HWY.QRSTWIDEN 'Gf LU
ALTER,REPAIR OR ABANDON HOUSE � CLI SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT U)
PERMIT NO. _ _ r--”' Z
— INDUSTRIAL
WASTE APPROVAL y--
OWNER'S PERMIT S 2; Oo CHARGES
AUTHORIZA'T'ION TOTAL FEE ` CONNECT]ONfihi RGE FEE
-'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON, REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING —
TO THE PUBLIC SEWER, APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF --�--
OWNER OR NEW HOUSE SEWER
OWNERS AGENT —
CONNECT ADDITIONAL
ADDRESS._ BUILDING Oft-7VOMIk -
_
SEPTIC TANK.SEEP,PIT(S) -
[ HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES
S AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM.
CALIFORNIA OR THAT 1-AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESPRIBEID RESIDENTIAL PROPERTY. ABANDON HOUSE SEW ER
SIGNATURE / --
OF PERMITTEE �L r_, s SACKFILL SEPTIC TANKS ❑ C31SEEP,PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT A. WOOD
CK. M.O. CASH
SUPERVISING MECHANICAL ENGINEER
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