HomeMy Public PortalAbout4811 RIO HONDO AVE_Sewer__ APPLICATION FOR PERMIT 1
76AG42D
S&E-6fi8 11-515
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDISS-LNG �;
."°`' "y, (•;'q ".
JOHN A. LAML3IE, COUNTY ENGINEERADDRE�.-�-- ---• _-
CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY .�
FORNEAREST_APPLICANT TO FILL IN NEARS sT, _ _
DESCRIPTION---LOT NO, __i--- OWNER d.���',�
BLOCK TRACT ADDRESS - "Vie
NO. OF BLDGS. M Vc, --
SIZE OF LOT NOW ON L07'__ - I� CITY TEL. NO.
USE OF - — DISTRICT NO.. - GROUP MAP
BUILDINGS
CONTRACTOR
A.DDRESs t _—_._—__—_--- CONNECTION DATA ^------.--__--
,/. STATION DEPTH
CITY y. TEL..: O.�",..p J . . MANHOLE REFERENCE . .------- - --`-- PPER_
Ijil,STATE ,Lr""+r _ ,-fJ�-LOWF,R
REGISTRATION N0, � I.r] COUNTY
NO, FJESCRIPT(ON_OFWORK fF� FEE.^. -
TYPE OF`CONNECTION -
----LENGTH R._ ..-.--------
HOUSE SEWER CONNECTING TO I Y. CURB P.L' M.L. TO P.L.
PUBLIC SEWER $3.50 I - — - ----
SEPfIC TANK SEEPAGE,PIT OR
PITS ANWOR DRAINFIELD CO) $3.00
UYERFLOW SEEPAGE Pit URAINFIELD T P C NO,
CX1N ,CESSPOOL,DRYW£i L,MANHOLE C $2.001 CD. IMP, NO. JOB NO.
HOUSE SEWER CONNECTING TO
j PRIVATE DISPOSAL SYSTEM - _ n, $1,Q0 I TRUNK PERMIT NO, ROAD.PERMIT NO.
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
- i WORK TO HOUSE SEWER ft. $1.00 0 PERMIT N0, -
j ALTER.REPAIR OR ABANDON HOUSE - --- -_.-- _--- -- ------ --� - -
SEWER OR DISPOSAL SYSTEM r<t $1.00 1 INDUSTRIAL
- - -_----.—_ ___--__---- -.-_ �=r___---_-- WASTE APPROVAL
CHARGES
I
- —.._------ _ CONNECTION CHARGE FEE
OWNER'S PERMIT _ $ 1 00 -- ----- — _-- �----
AUTHORIZATION TOTAL FEE ��- ' REIMBURSEMENT FEE
I i
I HAVE A7 THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. ---_--APPROVALS--.-_--._ - DATE----.�--_—.__I, E
__..-----�-_- "---.INSPECTOWSSIGNA+UR�_-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING i
TO THE PUBLIC SEWER. NEW HOUSE SEWER -
SIGNED THIS DAY OF--19--
CONNECT ADDITIONAL
OWNER OR - � BUILDING OR WORK
OWNERS ;-- "
%
w -_
ONERS AGENT-4'14- SEPTIC TANK SEEP
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION
AND STATE THAT.THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL,SYSTEM
I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED PY,LOs ANrELES COUNTY AND STATE OF ABANDON DISCHOUSONNECT
SEND
CALIFORNIA OR THAT I 1 THE LEGAL OVj ,:R OF THE ABOVE ----- - - -- - --r--- -- .-- ---
ER
DESCRIBED RESIDENTIAL P OPERTY. BACKFILL SEPTIC.TANKS G
SIGNATURESEEP_PIT(S) L CESSPOOLS❑
—
--,
OF PERMITT E'E -
IOHN A. LAMBIE.COU TY ENGINEER �d�iLIDATIO�d ROBERT A. WOOD-, CHIEF PLBO. INSPECTOR
t'
M.Q. CASH ..
R `'` {�j0 9 39"— OCT 77) 4