HomeMy Public PortalAbout4852 RIO HONDO AVE_Sewer__ 8A6420APPLICATION FOR PERMIT
E808 8-59 7
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. I.AMBIL County Engineer
IFF
CASSATT D. GRIN, Supt of Building -
LOCALITY�'-'�-'a-.�v.
FOR APPLICANT TO FILL IN FOR
CROSS ST.CX
LEGAL
DESCRIPTION LOT NO. OWNER,..MAIL
•
BLOCK TRACT 7 ADDRESS ` ® 1 .:„ Y� e +. •- t +�L.
N0.OF SLOGS.
SIZE OF LOT .,.� ,✓i � NOW ON LOT LCITY � ��”" TEL. NO.
USE OF
BUILDINGS 7 r [s y1 , DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR 1 tl f ftp sy j� FG X _ -
ADDRESSN e 6 H r.J � -�l v CONNECTIO DATA --
CITY ' TEL.ND.A A '7, y 6-r STATION DEPTH
❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ❑ COUNTY LOWER
No. DESCRIPTION OF WORK FEE r y ) y
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNEC ON LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y, CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO. - -
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP.NO, JOB NO,
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
d ALTER,` "HOUSE �,, STATE ENCROACHMENT
—SEWER M @ $1.00 1 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I _j z�r REIMBURSEMENT FEE
-1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS DAY OF 79_-___ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 SEWER$. SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT C AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL,PROPERTY? BACKFILLSEPT TANKS ❑
SIGNATURE SEEP,PIT(
S) ❑ CESSPOOLS ❑
OF PERMIT E15=0
VALMATIOPy ROBERT A. WOOD
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CK, X.0. CASH SUPERVISING MECHANICAL ENGINEER
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