HomeMy Public PortalAbout5755 RIO HONDO AVE_Sewer__ '6A Laos2-6866 APPLICATIONFOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS r
COLEMAN W. JENKINS, SUPT. OF BUILDING
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN `ROSS ST.
LEGAL
DF
SCRIPTION LOT NO. OWNER
MAIL '5 -
BLOCK TRACY ADDRESS
NO. OF BLDGS. 1
SIZE OF LOT NOW ON LOT / CITY TEL,. NO,
USE OF
BUILDINGS DISTRICT Nb. GROUPJ MAP PROCESSED BY
- BK PG
CONTRACTOR
ADD S -o y / CCCJJJ /CONNECTION DATA
ClTV C J",-T-EL, NO. -/f,..o � Y STATION ,�L 7/ - , DEPTH
STATE -LIC -� ,.. / �+ •J � UPP
LICENSE MCI GLASS V MANHOLE REFERENCE '9
____ Com- a LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CTtON LENGTH FROM ,.,,, �r .�'�
HOUSE SEWER CONNECTING TO A. /`9 Y. URB P.L. M.L.TO P.L. `�/f
PUBLIC SEWER $5.00 '4N
i SEPTIC TANK,SEEPAGE PIT OR ` P.C.NO.
PITS AND/OR DRAINFI€LD �_ SIO.00 CO.IMP. NO. 13! .JOB.NO-
JH �) _ J
OUSE SLWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.c.� �[
TI PRIVATE DISPOSAL SYSTEM @ $3.00 / 5_7V
CONNECT ADDITIONAL BLDG OR i AFFIDAVIT wAaY[R [AS[M ExT RECORD.INSTR.NO DATE CD
WORK TO HOUSE SEWER @ $3.00 f�
i OVERFLOW SEEPAGE PIT.ORA INFIELD � �.
EXTN.,CESSPOOL.DRYWELL.MANHOLE @ $5.00
ALTER,kEPAtR OR ABANDON HOUSE - HWY.OR ST'.WIDENING
T
{SEWER 4R DISPOSAL SYSTEM^_@ $3.00 1 I _ ---'-- - - ------ L�
--- -- ------ - i - STATE EIVC ROACH M.EN7 �
PERMIT NO..__-.�__
----'--"--'-------'— -h-'--^- INDII STRiAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT _ S! 2; oo — — ----- -- --
AUTHORIZATION TOTAL FEE —�— h CONNECTION CHARGE FEE-!- -- —
1 HAVE AT THIS DATE A CONTRACT I THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO-CONNECT THE ABOVE GR BED EXISTING DWEL G --- ---------
TO THE PUBLIC SEWER, APPROVALS DATE INSPECTOR'S. IG ATURE
SIGNED THIS DAY O 19 — -- -- — - --
OWNER OR NEW HOUSE SEWER
OWNERS.AGENT_ i * __
✓'
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
, -!_.�i._L _
(S)
I HEREBY ACKNOWLEDGE THAT I H V SEPTIC TANK,SEEP,PIT
READ THIS APPLICAT ON AND/OR DRAINFIELD
ANO STATE THAT THE A VE CORRECT AND AGREE TO COMPLV
WITH ALL COUNTY OR N ES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL [] I
1 HEREBY CERTIFY A AM PROPERL EGIST - ANO/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIR LOS ANGLES NT STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT i THE LEGAL OW O INTEND TO —'�— -----"
DISCONNECT PLUG AND
RESIDE. IN, THE ABO SCRIBED
RESIDE
O RTY. gggNDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS
OF PER MTTTEE_ SEEP.PIT(5) 0 CESSPOO S..
VALIDATION JAC*R%L L
CK. M.O. CASH
SUPERVISING MECHANICAL ENGINEER
�
a,