HomeMy Public PortalAbout6259 RENO AVE_Sewer__ .-I
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76A 642D 2!70 APPLI "'GAN FOR PERMIT
76A 6 .
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FCROSS
NG
JOHN A. LAMBIE, COUNTY ENGINEER 55 -
COLEMAN W. JENKINS, SUPT. OF BUILDING
LOCALITY „�•' �, ��JCY -_-
FOR APPLICANT TO FILL IN ST
y�
(PRINT OR TYP I ST_
E ONLY)
D_ESCRiPT ON_ LOT NO ✓ _ --__ OWNER e 6lrAj
MAIL q f
BLOCK TRACT _ ADDRE55 }_ ,✓,�} --,_
NO. OBLDGB
SIZE OF LOT 1 NOW ON LOTy''� CITYTEL. NO
__ ^�
BUILDINGS i< -� f /'LiS,� DISTRICT NO. GROUP CLASS MAP PROCESSED 6Y
BK PS
r
CONTRACTOR -fdl..Y_rL` + J-L.`�'IIc �'" �" � .'S A --a .f�. >l k-'I`
ADDRESS, %- ' .. _u—. __— _ CONNECTION DATA
,�y �: STATION �. V DEPTH r �
r "` - MMMMEEE
CITY� '� �'G..'-- ,TEL. NO. �.
STATE LIC
LICENSE NO. CLASS MANHOLE REFERENCE ,E - -
LOWER
FE
No. DESCRIPTION OF WORK E _ TYPE of CO
__— __ ___ _ IYNE,GTION LENGTH FROM
HOUSE 5 W R CONNECTING TO i Y (" URB:_-- P.L. M.L.TO P.L.
IPU ELIC SEWER $3,06 P.C.NO. -" --'
SEPTIC TANK.SEEPAGE PIT OR /,
_ i PITS AND/OR DRAINFIELD @ $10.00 CO_IMP.NO. 0 JOB NO.
—s HOUSE SEWER.CONNECTING TO 'TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
/Ip CONNECT ADDITIONA - J AFFIDAVIT �vatYEB-TEASE MEkt—'j RECORD. INSTR.NO. j� DATE 0
lk WORK TO HOUSESEWER _ ___-_-_@_ $9.00
�S OVERFLOW SZEPAGE PIT.DRAINFIELD -_-
EXTN,CES5POOL..DRYWELL,MANHOLE @ $3.00
--- � HWY.QRST.WIENPNG 19
ALTER, . � JQ
F_--
S W_R pR DISPOSAL SYSTEM STATE ENCROACHMENT (J'
PE RM 17 NO. Lu
--`} INDUSTRIAL
WASTE APPROVAL
_._--______-_..___�__-- CHARGES ._.-
OWNERS PERMIT $ _ 31-0-0
----- ----------- - - -
1- - CONNECTION CHARGE FEE
AUTHORIZATION T TOTAL FEE e I o d� __--_--- —'-- ---------__--_
IHAVE AT THIS DATE A CONTRACT WITH THE. HEREIN NAMED CON- REIMBURSEMENT FEET DATE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
P � APPROVALS
TO THE UBLIC SEWER. "" a INSPECTORS SIGNATURE
S I G N E D T H I S6A F - 19 r r, — - --- -------�}----t-`---— -- --
OWNER OR �. ; -/ NEW HOUSE SEWER
OWNERS AGEN ...".. -
- � CONNECT ADDITION �
i
ADDRESS-r +" BUILDING OR WORKce_+
-- - -- - -- — '--'--' - SEPTIC TANK,SEEP,PiT(S)
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE I5 CORRECT AND AGREE 7O COMPLY AND/OR DRAINF'I ELD
WiTH ALL C;OUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELLCL
HEREBY CERT!'Y THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR � �
LICENSED AS REO IRED-BY LOS ANGLES. COUNTY" AND STATE OF SEWAGE DISPOSAL SYSTEM
A.L.'FORNIA OR TH T A TMECffi,GAL pWN OF. AND INTEND TO pISCON NECT PLUG AND
R SIDE, IN, THE A V_
THE PROPERTY. !
- ARAN qN HOUSE SEWER
SIGNATURE - - ---- - - - —_t-
O.F PFRMITT
_ _.4.-�- -_ BACKFILL.SEPTIC TANKS
/ SEEP.PIT(S) ❑ CE SSP)OLS ❑!
~--VALIDATION JACK R. ALLEN
CK. SUPERVISING MECHANICAL ENGINEER
M.O. CASH