HomeMy Public PortalAbout6105 SAINT JAMES DR_Sewer_8/31/1965_ ' c
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CE808 1
GA54 to-ea APPLICATI N FOR PER IT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGIIIiEER
BUILDING AND SAFETY DIVISION BUILDING
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WILLIAM A 1EN9E17 SuP I of euildfp7 LOCALITY
NEAREST
FOR APPLICANT TO FILL IN DRGap
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DESCRIPTION LOT NO OF OWNER
MAIL JE
BLOCK TRACT ADDRESS
O OR OLOGS
SIE[ OF LOT NOW ON LOT CITY T TEL NO
Ua[ OF
EUILDIN DISTRICT NOGROUP MA PROCESSED BY
CONTRACTOfl 3A0 U
ADDRESS CONNECTION DATA
STATION// DEPTH
CITY TEL V77
STATE MANHOLE REFERENCE HIAA•
REGISTRATION NO COUNTY LOWER
NO DESCRIPTION OF WORK FEL TYP[OF CONNECTION LENOTH FROM
popHOUSE SEWER CONNECTING TO Y CURE P L ML TOIL Y
PUBLIC SEWER 0 $a OO CL
a[PTIC TANK SEEPAGE PIT OR P C NO O
PITS AND/OR GRAINFIELD B [1000 CO IMP NO �zijJOB NO V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO BE
PRIVATE DISPOSAL SYSTEM O00 O
CONNECTADDITIONAL BLDG OR f AFFIDAVIT MT [A[[RaET RECORD—IN ST11 NO DAT[
WORK TO HOUSES[W[R • BS 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EETN CESSPOOL DRYW[LL MANHOLE 6 IS. y OR IDB I O w
ALTER REPAIR OR ABANDON HOUSE Z
SEWER OR DISPOSAL SYSTEM 53OD STATE ENCROACHMENT
PERMIT No
INDUSTRIAL
WAR[APPROVAL
OWNER'S PERMIT s x o0 CHARGES
AUTHORIZATION TOTAL FEF CONNECTION CHARD[FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TD CONNECT THE ABOVE DESCRIBED ST N
TO THE PUBLIC SEWER APPROVALS DAT[ INSPECTOR S SIGNATURE
SIGNED THIS DAY.OF IB
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HERERY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION S[71C TANK BCLP PITI$I
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY '[ND/OR DRAIXPItID
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU MSINO ANO SEWS CESSPOOL ❑ DRYWCLL ❑
1 HER[aY C[ AT 1 AM POOP LY R[GI [RED AND/OR ALTER REPAIR SEW QR OR
LICENSED AS UI O SY LOS AN C UN AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA TH I AM THE LC W R AND INTEND TO DISCONNECT PLUG AND
n[SIDE IN E DYE DESCRIBE R ID R ABANDON HOUSE SEWER
SIONATUR ❑
OF PERMITTEE SACKFILL&[PTICTANKS
S![P PITIS) ❑ CESSPOOLS
pALIDApIO� ROBERT A WOOD
- CK M o c[pX SUPERVISING MECHANICAL ENGINEER
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