HomeMy Public PortalAbout6142 RENO AVE_Sewer__ E806 3-62
6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu1LDINc
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ' a ,+
COLEMAN W. JENKINS, SUPT. OF BUILDING
LOCALITY
NEAREST
FOR APPLICANT TO�FILL
* IN
C.OSS 5T. --
LEGAL _---- �r :S� C L`J � -_-
DESCRIPTION LOT NO. `! OWNER
--�-- MAIL
BLOCK TRACT ! 0- ADDRESS
NO. OF BLOGS.
SIZE OF LOT NOW ON LOT µ,ye'^O - CITY TEL. NO
USE OF
BUILDINGS - DISTRICT NO: GROUP MAP PROCESSED BY
BK PG
CONTRACTOR.,,.
ADORES .N '. ' _" . _ qqq CONNECTION
-- - - ^$ ST ATION DEPTH - If ---
CITY ; TEL. NO.STA
LIC - LIC- ,y� MANN OL£REFER ENC ,Y � o'
LICENSE NO s CLASS_e � ,/ CI' � �� LOWER:%'
NO i DESCE 1'104 OF VVO K FEE -
_ __ _ YPE Off'CS,WfJi&i6d ION LENGTH OM
rH OUSE SEWER.CONNECTING TO 3 Y. CURB �I. P.L.. M.L.70 P.L. ,.
I PUBLIC SEWER $5 00 �--- v,
,(J,{ P.C.NO. 11
SEPTIC TANK SEEPAGE If OR
DRAINF1ELD _� $1
CO.IMP.NO. "� JOB NO. -
_PITS ANDI OR _ 0.00 1 "
HOUS.ESEW ER'CONNECTING TO I TRUNK PERMIT NO. -ROAD PERMIT NO.9� l
PRIVATE DISPOSAL SYSTEM $3.00 1 ✓ 0
ONNECT ADDITIONAL BLDG.OR AFFIDAVIT rwAlv[q (ASFME Nt RECORD,INSTR.NO. DATE
W ORK TO HOUSE SEWER @ $3.00 1
- PA ---------+ -}-- I mo - Lu
SEEPAGE PIT.DRAINFIELD _ Lu
I EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 (n
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
__SEWER OR DISPOSAL SYSTEM __ 0 $3,00 E STATENCROACNM ENT
- PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER`S PERMIT _ $ 2' 00- T _ _CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE - -
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - -- -'-'-
TO THE PUBLIC ,$•G1�ER. APPROVALS DATE IN PECTOR' IG TURE
SIGNED THIS+ �1 DAY O f 18_ ---- `----"--"- - -- '-'
OWNER OR ,/j / ,r, NEW HOUSE SEWER .�,,, / _L✓
s` a
OWNERS
AGENT CONNECT ADDITIONAL "
BUILDING OR WORK
A DD RE SS _
----"-'— —'-- - ----"- SEPTIC TANK,SEEP,PITS)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THA-1 THE ABOVE 15 CORRECT AND AG R:EE TO COMPLY -----.—.-.------------ ----
WITH ALL COUNTY ORD
]NANC ES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
{ HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM 11
CALIFORNIA. OR T 7 I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN,
THE
As E DESCRIED RF, IOENT L PROPERTY. ABANDON HOUSE SEWER
SiGNATLI RE
OF PERMTTTE _ - ,,^`Y J BACKFILL 5EPTIC TANKS E3
SEEP.PITS)f ❑ CESSPOOL
VALIDATION JACK R. ALLEN
v`S�dr CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER