HomeMy Public PortalAbout6116 RENO AVE_Sewer__ 76AE42a
E-669 x.55 FOR OR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL,
Department of County Engineer
County of Los Angeles BUILDING y
AODRESA� �
WM.J. FOX. COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT oP SumDmg LOCALITY
-NEAREST
FOR APPLICANT TO FILL IN CROSS ST-__(
LEGAL
DESCRIPTION LOT NO. !:,+' 56 '-j-- '47- �+ - OWNER
BLOCK TRACT C' - MAIL
ADDRES'S
NO. OF BLDGS. _
_
__SIZE OF LOTNOW ON LOT ,/� CITY y. TIL N
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USE -r r .
NMI
BUILDINGS ��'�,, � DISTRICT NO. I GROUP MAP
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CONTRACTOR
ADDRESS_ e ,, -` ----` CONNECTION DATA
CIT: L. NO. - STATION DEPTH
A E _MANHOLE REFERENCE t _UPPER
ft EGIS7RAT1 Nq, ./❑ COUNTY --.--_----- --.-- -4R.�..
N0. DESCRIPTION OF OF WORK ` FE�_11 _ _ -- .-.--- _— -- -
TYPE OF CONNECTION LENGTH FROM
HfiUSE SEWER CONNECTING TO ,}
F�'"T _ lA.L,70 P.L.
PUBLIC SEWER Cn S 9.50_1 _ - -. --__ _. -.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
f CONNECT ADDITIONAL BLDG.OR _ P C. NO.
WORK TO HOUSE SEWER 1.00 CO. IIA.P N.O. .IOD NO
ALTER OR REPAIR EXISTING -
_ SEWER OR DISPOSAL SYSTEM "1.0_0 TRUNK PERMIT NO. ROAD PERMIT N0.
DISCCNNECT AND ALIA1 DON SEWER STATE E14CR-DACHIAENT
ANNOR DISPOSAL SYST'. _M _-1_.00 -,--- " 4
RIT NO.^
SEPTIC TRIAL TANK,SEEPAGE PIT OR
PITS AND/ DRAINFIE:LD 2.00 INDUSWAST tNUU� APPROVAL
CESSPOOL DRYWELL
SPECIAL CONDITIONS ONLY 2_00{ CHARGES
—E --- --- -( —... --
OWNER'S PERMIT 1 f 00- CONNECTION CHAGGE FEE
AUTHORIZATION TOTAL FEE � � � �' REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NIAAAED CON- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR 'TO CONNECT THE ABOVE DESCRIBED EXISTING DF E LINT,
TO THE PUBLIC SEWER - `�'.----"'-- --I-- ---- —
� v, IrEW HOUSE Si_WER
SIGNED THIS ' - DAY OF_, _ 19T
OWNER OR � � ,,.� CONNECT ADDITIONAL
.,.� - ,.,, •-x, BUILDING OR WORK
OWNERS AGENTS
1 _
"'- - -------- --�-. --- - .—.--
ADDRESS SEPTIC TANK,.SEFP, PIT(S) —
- AND/OR D_RAINFIE_LD
t HEREBY ACKNO'NLEDG£ THAT I HAVE READ THIS APPLICATION CESSPOOL[DDRYWELL❑ ^
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ —
PLUMBiNG AND SEWERS. ALTER, REPAIR„SEWER OR —
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR --SE4"J-----AGS-'"DISPOSAL SYSTEM-�-�— --
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER -
DESCRIBcD RESIDENTIAL. PROPL•RTY, BACKFILL SEFfi{.TANKSI,.- -
�l ' T. PIT a C SSPOOLS
SIGNATURE
OF PERMITTE£
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF FLOG. INSPECTOR