HomeMy Public PortalAbout6120 SAINT JAMES DR_Sewer_8/31/1965_ CES0 tD-09
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION eu1LOING
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REGISTRATION NO COUNTYMANXOL[REFERENCE / UPPER
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NO DESCRIPTION WORK IB[ ryPC OF CONNECTION LENGTH FROM 8
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PUBLIC SEWER O
SEPTIC TANK S[[PAOE PIT OR [B W P C NO O
PITS AND/OR GRAINFIELD O SIO DO CO IMP NO JOS NO V
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM O S300 TRUNK PERMIT NO ROAD PERMIT NO /�.
CONNECT ADDITIONAL°LDO OR AFFIDAVIT RMT[t [[[[M[RT RECORD INS" NO OAT[ v
1 WORK TO HOUSE SEWER O °300
OVERFLOW SEEPAGE PIT GRAINFIELD
KXTN CESSPOOL ORYW[LL MA NHOLI O °900 HWY OR ST WIDENING h
ALTER REPAIR OR ANDD OUSE
SEWER OR DISPOSAL BYST[M O 63 00 STAT[ENCROACHMENT
PERMIT NO
INDUSTRIAL
��T�T�p WASTE APPROVAL
OWNER'S PERDQT s Q OO CHARGES
AUMORIZATION TOTAL FEE CONNECTION CHARGE FEC
I NAV° AT THIS DATE A CONTRACT WITH THE H° CIN NAMHD CON REIMOURSEM[NT IC[
TRACTOR TO CONNECT THE ABOVE DESCRIBED
TO THE PUBLIC S[W[R APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS D Y 7g_
OWNER OR NEW HOUSE SEWER
OW NERS AO[NT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION °CPTICTANK SEEP PIT(S)
AN STATE THAT THE ABOV! IS CORRECT AND AOREC TO COMPLY AND/OR GRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLU M°INO AND SEW CRS CESSPOOL ❑ DRYW[LL
1 H[REMY C[ FY THAT I AM PROPERLY RCOIPT[RED AND/OR ALTER REPAIR SEWER ON
EMBED
FRED BY LOS ANGLES COUNTY AN STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNI R AT 1 AM THIS LEGA` Oy'N[R 01 AN INTEND TO DISCONNECT PLUG AND _
RISIOB HH SOV DISCRISEO/VR�Sj(/T�-ENTI PRO RTY ABANDON HOUSE SEWER
mor AP[ I BACKFILL SEPTIC TANKS ❑
PIT(S) ❑ CESSPOOLS
Vj{LIDATTON_— ROBERT A WOOD
CK M o /C�ABXJI SUPERVISING MECHANICAL ENGINEER
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