HomeMy Public PortalAbout5711 RIO HONDO AVE_Sewer__ EAS,2!6'^J 3 t
S& APPLICATION FOR PERMIT 1
S E'.- 2..8d
DIVISION OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING �"` p • 1
WM.J. FOX, COUNTY ENG:INEI3R ADDRESS [ / ��! t A�NIG7
CASSATT D.GRIFFIN,SUPT ot= BUILDING LOCAL ITY ° -. ...�. CLL ( .,
Ya"
FOR APPLICANT TO FILL IN NEAREST �"g /[
CROSS ST,
LEGAL - ..: �. _..._ ...,,..
DESCRIPTION 1,C7 N0. OWNER
BLOCK TRACT Fey' .��r � MAIL F
-- --- ,� ADDRESS n �G
NO. OF BLD GS. _f
S 17E OF LOT* NOW ON LOT {n.-I.A CITYj� _ TEL.NO.ail
�.
USE OF
BUIiDINS` r t_ DISTRICT N6. .GROUP I MAP
CONTRACTOR y _ .. • — I 8K: PG
ADDRESS CONNECTION DATA
CITY TEL. N0. STATION DEPTH
❑ STATE IVANNOLE REFERENCE
REGIn
REGISTRATION N0. (] COUNTY .�.-_. _ ._� ':R _ LOWER
-- �— TYPE OF CONNECTION LENGTH FROM -------
NO, DESCRIPTION OF WORK FEE ". - CURB !1.L.-. M,t is P.L.
�I `SOUSE SEWER CONNECTING TO
PUBLIC SEWER @ ;S 3.50
HOUSE.SEWER CCN NEC 11 NG'TO
I PRIVATE DISPOSAL SYSTEM 1.00_I I_
CONNECT_kpDITi0Ys1L BLDG. OR I 1 CO, IMP. NO. .106._RfO.
_
WORK TO HOUSE SEWER_ 1.00 II
' ALTER OR REPAIR EXISTING �
I EWER OR DISPOSAL SYSTEM I.Ob j I TRUNK PERMIT NO. ROAD PERMIT N0.
1 DISCONNECT AND ABANDON SEWER j _ - STATE ENCROACHMENT
ANO/GR_ O,SPOSAL SYSIEhl 1.00 . P RSiIT NO,
SEPTIC TANK .SEEPAGE PIT OR
PITS AND/OR DR.AINFIELD 2,00 ) INDUSTRIAL
~i ESSPOOL-DRYRLL I WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2,00
-- -- — .— --- CHARGES
i CONNECTION CHARGE FEE
PERMIT
OWNER'S 1 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE CALa7
THIS DATE CONTRACTED WITH THE HEREIN NAMED CSN- APPROVALS DATE INSPECTOR'S SIGNATURESIGNATURETRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST'iNG DWELLING �I
TO 'THE PUBLIC SEWER - '-- "-"----
NEW HOUSE SEWER^ ----- --��
SIGNED TH;SDAY OF—J41 -`:,
OWNER OR ;F CONNECT ADDITIONAL
OWNERS AGENT - _ BUILDING OR WORK _
' r ,. EPTIC TANK, SEEP,PIT($)
AND/OR DRAINFIELD
1 HERESY ACKNOVILEDGE THAT I HAVE READ THIS APPLICATION" CESSPOOL Q DRYWELL Q
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY __
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS' - SEWAGE DISPOSAL SYSTEM
I HERESY 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 ABANDON HOUSESkWER _ -
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS O1
r SEEP,PIT(S) Q CESSPOOLS Q
,Fr
SIGNATURE . - �..
OF PERMITTEE
WILLIAM J. PDX,C UNTY ENGINEER VALIDATION p
BY A4t G G7 a fti S `tel e+ ,C.�. 0 �
DEPUTY DEPUTY
BY ' BY
-0 DEPUTY DEPUTY