HomeMy Public PortalAbout6114 SAINT JAMES DR_Sewer_8/31/1965_ CEBOS O lona
6A54 APPLICATION FOR PER
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
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No DESCRIPTION OF WORK PEE TYP[OP CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB L ML Torl.
PUBLIC _ [900 PC NO fl/ O
REPS ICTANKANK f [PAGE PR Olt CO IMP NO JOBNO
RE"AND/OR GRAINFIELD 0 [1000
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO K
PRIVATE DISPOSAL SYSTEM m iS GO
CONNECT ADDITIONAL BLDG OR AFFIDAVIT N1n111 ......I RECORD INETR NO DAT[ W
WORK TO XOUBE SEWER O iS OO
OVERFLOWSEKPAOE PIT GRAINFIELD
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ALTER REPAIR OR ABANDON HOUSE HWY ORST WIDENING y
SEWER OR DISPOSAL SYSTEM C [l GO STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
�t1[iCO WAST[APPROVAL
OWNER'S PERII'Dr f 2 OO CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE F[[
1 HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT F[[
TRACTOR TO CONNECT THE ABOVE DESCRIBEDDWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR B SIGNATURE
SIGNED THIS DAV OF IG_
OWNER OR NEW HOUSE DOWER
OW N[Rf AGENT
J CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
![EIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO/OR DQAINPICLD
AND STATE THAT TH[ ABOVE li CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWCLL ❑
I HEREBY CERTIFY THAT I AM PROPENLY REGISTERED AND/OR ALTER REPAIR SEW"OR
LICENSED Af RE 1 BY LOS ANGLES COUNTY AM STAT[ OF SEWAGE D16P05AL SYSTEM
CALIFORNIA
OR AM TX[ LEGAL O R 01 AN INTEND TO
DISCONNECT PLUG AND
RES 10[ IN • DESCRIBED R[ IA RO RTY ABANDON HOUSE SEWER
fIOFATURE
ERMITT AWKFILL SEPTIC TANKS ❑
SEEP PIT(B) ❑ CESSPOOLS
1JALIDI{7ION^ ROBERT A WOOD
CN M o ��AiH SUPERVISING MECHANICAL ENGINEER
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