HomeMy Public PortalAbout6146 RENO AVE_Sewer__ 6A 642D -CE808-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING / w-7
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ADDRESS W /P j (vr- Al tJOB
LOCALITY _/�-����'+' (d [..�'( l
NEARE
FOR APPLICANT /T/�„O FILL IN ICROSSSST.J/� {/AI 9 /LEGAL � � �✓'DESCRIPTION LOT NO OWNER
'' MAILBLOCK TRACTADDRESSNO. OfF SIZE OF LOT NOW ONBLOTS Cf7Y TEL. NO.USE OFBUILDINGS DISTRICT NO.LT-
ROUP MAP
_ 8K pG
CONTRACTOR AY/ \ '� - L -
ADDRESS CCE . - ,,�OC� CONNECTION DATA
TEL. NO. STATION )) DEPTH
CITY Cc`� � � ` tJ.'•��; j• �i
STATE LIC (.'
LICENSE NOS GLASS MANHOLE REFERENCE 77-'5
JI:LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF Cp G ION LENGTH FROM LK y
HOUSE SEWER CONNECTING TO �y Y. CUR P.L. M.L-TO P.L.
PUBLIC SEWER 0 $7.00 6 P.C.NO,
SEPTIC TANK.SEEPAGE PIT OR j ``J' JOB NO,
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. ! rrr---���
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO Dom„
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PRIVATE 015POSAL SYSTEM $3.00 0
CONNECT ADDITIONAL.BLDG.OR AFFIDAVIT WAITER -EASEYEN7 RECORD. INSTR.NO. DATE
WORK TO HOUSE SEWER $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD DL
EXTN.,CESSPOOL.DRYWELL. @ $5.00 HWY. OR ST.WIDENING o
ALTER,REPAIR OR ABANDON HOUSE I-
___SEWER OR DISPOSAL SYSTEM II; STATE ENCROACHMENT Lu
MANHOLE PERMIT NO. D.
® $7.00 -- — to
---- — INDUSTRIAL
WASTE APPROVAL Z
CHARGES
OWNER'S PERMIT s 3 00
AUTHORIZATION TOTAL FEE y4) CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -- APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19
OWNEROR NEW HOUSE SEWER
OWNERS AGENT 1, CONNECT ADDITIONAL
BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT-[ HAVE READ THIS APPLICATIO AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ---
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
I 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 L-AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE A�- Zff'
ED RESIDE IAL.PROPERTY. A BANDON HOUSE SEWER
SIGNATURE `✓ tiBACKFILL S;£� K14-�OF PERMITTEE
„•`e� CESSPOOLS
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VALIDATION CK. M.O. CASH