HomeMy Public PortalAbout4915 RIO HONDO AVE_Sewer__ 76AC42D
APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUIL"I"c'
WM.J. FOX. CouNTY ENGINEER
CASSATT 0.GRIFFIN, SUWT OF SUALDINO LOCALITY
NEAREST
ST.
FOR APPLICANT TOWL IN CROSS
15F5�CRLPTION_LqT No, OWNER
BLOCK TRACT MAIL
.-ADDRESS
NO. OF BLDGS. 01"
_517E OF L T NOW ON LOT CITY EL. NO.
USE OF
-JILL"L—_DINGS DISTRICT NO. GROUP I MAP
A.
SK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY EL STATION DEPTH
-STATE MA144OLE REFERENCE F
REGISTRATION NO, COUNTY
NO. ! DESCRIPTION OF WORK FEE
Hous WEIR CONNECTING T TYPE OF CONNECTION LENGrH FPOM
_E SE Y.
PUBLICm'rR aw $ 3,50 _CiJRB P L ML. TO P.L,
----------
Sr
HQUSt SEWER CONN E CT 1 NG TO
E DISPOSAL SYSTEM, 1.00
CONNECT ADDITIONAL BLDG.OR PC. NO.
'WORK TO HOUSE SEWER LOO CO. 1114p. NO. 2�o?
ALTER OR REPAIR EXISTING TRUNK PERMIT NO.
_SEWER OR DISPOSAL SYSTEM 1.00 ROAD PERMIT NO,
DISCONNECT AND A9.NDON S_1h ER
AND/OR DISPOSAL,SYSTEM STATE ENCROACHMENT
PERMIT NiO.
SEPTIC TANr,SEEPA
PITSZID/OR DRAIN FULD INDUSTRIAL
WASTE APPROVAL
CESSPOOL-DRYWELL
SP�L
:CIAL CONDITION-,ONLY 2.00
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 5
00
AUTHORIZATION TOTAL FEE 4- REIMRURSEMENT FEF
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAtD CON-
TRACTOR TO CONNECT THE ABOVE DES'CRIBIED EXISTING DWELLING APIMOVALS DATE INSPECTOR'S SIG iATURE
' UB
'To TFE P LkC SEWER
NEW HOUSE Sz4LR
SIGNED THIS —DAY
0'k,'IN E iz OR ''' r a. ,,)'' t CONNECT ADW 1"IONAL
OWNERS ADEN "' BUILDING OR
2 —-----WORK--
DRESSSEPTIC TANk, SEEP, PiT(S)
--------- ANWOR DRAINFIELD
RFREFkY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'CESSPOOL[D DRYWELL Fj
AND STATE THAT THE ABOVE: IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR
SEWAGE DiSPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABA14DON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S) Cj CFFSP66LS 0
SIGNATURE
OF
WILLIAM J.FOX,COUNTY ENGINECP VALIDATION R.A.WOOD.CHIEF PLEG. INSPECTOR