HomeMy Public PortalAbout6222 RENO AVE_Sewer__ CE8083-64
76A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B ADDRESS ,BUILDING
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building
LOCALILI
TY
NEAREST
0 SS
FOR APPLICANT TO FILL CROSS
ROSS ST.
LEGAL—
DESCRIPTION LOT NO. .W OWNER
MAIL
BLOCK TRACT ADDRESS
IN 0OF 13LDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE LDINGS GROUP OF DISTRICT NO. MAP ,PROCESSED BY
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CONTRACTOR ✓ e:, '
ADDRESS CONNECTION DATA
STATION
DEPTH
CITY TEL, NO. -,y -7e e
'-
STATE
MANHOLE REFERENCE PE
REGISTRATION N 0, COUNTY
No
- T - -
GES cRi0—TiON OF WORK FEE TYPE OF CON;:CTION LENGTH FROM
HOUSE SEWER CONNECTING To Y. CUR
U P.L, M.L.TO P.L.
PUBLIC SEWER----- @ $5.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO.JOB NO,
PITS ANO/OR DRAINFIELD $10.00 CO, IMP.NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 0
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT
SMENT RECORD.fNSTR.NO. DATE IX
WORK TO HOUSE SEWER 0 $3.00 0
OVERFLOW—S EE—PAG EPTT-0-R—ki N FIELD
EXT N.,CESSPOOL,DRYWELL,M A NH OLE 0 $5,00 U
ALTER, U REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING LU
SEWER OR DISPOSAL SYSTEM @ $3.00 CL
STATEIENCROACHMENT (11)
PERMIT NO. z
INDUSTRIAL
—T WASTE APPROVAL
CHARGES
OWNERS---I PERMIT $! 2 00
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR
R TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
To THE PUBLIC SEWER. APPROVALS DATE INSPECT;ts SIGNATURE
SIGNED THIS—DAY OF 19
OWNER OR NEW HOUSE SEWER el;
OWNERS AGENT— CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS— SEPTIC TANK,SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CESSPOOL 0 DRYWELL ❑
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,RE PA I R.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF 5 EWAGE DISPOSAL SYSTEM
CALIFORNIA
A OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG.AND
RESIDE IN, THE ABOVE: DESCRIBED RESIDENTIAL PROPERTY- ABANDON H OU SESEWER
SIGNATURE
BACKFILL SEPTIC TANKS
OF PERMITTEE
SEEP,PIT(S) ESSPOOLS
VALIDATIONROBEI
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
Ur yr
0 0
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