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HomeMy Public PortalAbout6115 SAINT JAMES DR_Sewer_8/31/1965_ 0010-a3 TOAGADIED APPLICATI N FOR PER IT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER , BUILDING AND SAFETY DrMlON FADDRtS iiOFIN ALAM M County EBpInw Nm.LIAM A ]ERSER supt d BuildmGFOR APPLICANT TO FILL IN OALDESCRIPTION LOT NO BLOCK TRACT NO OR SLOGS SIZE OP LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP PROCESSED NY BUILDINGS wSK PG L01lTRACTOR �E/ YY ADDRESS / CONNECTIO ATA OZ4 T- cST CITY �J `J TEL ATION DEPTH REGISTRATION NO O e ATL MANHOLE flIRSR[NCC UPPER COUNTY NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB AIL TO P L r PUBLIC SEWER • CS OO SEPTIC ANK SEEPAGE PIT OR PC NOD- PITSAND/ORGRAINFIELD [1000 CO LMP NO JOE NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V PRIVATE DISPOSAL SYSTEM Sam QT. CONNECT ADDITIONAL SLOG OR AFFIDAVIT ROvq wupi RECORD INS TR NO DATE O WORK TO HOUSE SEWKR O SS 00 OVERFLOW SEEPAGE PIT DRAINFI[LD EETN CESSPOOL ORYWELL MANHOLE 0 {S 00 HWY OR BY WIDENING ALTER REPAIR OR ABANO DU• 40 Z SEWER OR DISPOSAL SYSTEM 10 13 00 STAT[ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL � IMM O tF lyL{i S PERMIT f 1 00 CHARGES AUTHORIZATION TOTAL FEE LCSSB�OL ONNECTION CHARGE FEE I HAVE AT THIN DAT[ A CONTRACT WITH THE HEREIN H MED EIMBURSIDR�XLL T FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWEL TO THE PU'LIC NEWER APVALS DATE INSPECTOR N SIGNATURE SIGNED THISY OF 1 OWNER OR W NOWER OWNERS hG[NT� MMCCT IONAL ILDINGORK ADDRESS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICAPTIC TAEP PIT(S) AN0 STATE THAT THE ABOVE IS CORRECT AND AGREE TO COND/OR OIELO WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULA PLUMBING AND SEWERS SBPOOLDRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANLTER RESEWER ORLICENSED AS RE D BY LOB ANGLES COUNTY A D STATWAGE DAL SYSTEMCALIFORNIA O A I AM THE LEO WNER P D INTENSCONNEUO ANpRE8106 IN { A Vt DESCRIBE SID[N L P OP[RTYANDON E SEWERSIG NATURCKFILL TANKS ❑DP P{R 1 P''PIT^f CESNPOOLS VALAll 0 ROBERT A WOOD CK M o CASH J SUPERVISING MECHANICAL ENGINEER 111� 4 2 6 "i AUG j 1 0 D 700- s