HomeMy Public PortalAbout6121 SAINT JAMES DR_Sewer_8/31/1965_ 6AOB lo-Sa APLICATI N FOR PE MIT
C S08 1 P
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BulLDINa
,n.av A L MIIIE County E.= �r AODR[ee
W}LLI/4M A IENSEN Sup( of Duilmn4 �—
LOCALITY
NLM[aT
FOR APPLICANT TO FILL INLECAL
DRoaa aT
DESCRIPTION LOT NO OWNER
MAIL r
BLOCK TRACT ADDRESS
N OF Daa
812E OF LOT NOW ON LOT CT' log TEL NO
USE OF
UUILOINOS DISTRICT NO GROUP MAP PR ee[D[Y
CONTRACTOR T�O V S /3/
ADDRESS,4 ae CONNECTION DATA
clTv rtL STATION DEPTH
{TATE MANHOLE R[F[R[NCE UPPER
REOIS11RATION NO COUNTY
No DESCRIPTION OF WORK F[[ TYPt OP CONNKCTION LEND"FROM
HOUSE SEWER CONNECTING TO Y CURB ML TO P L }
PUBLIC SEWER O [SOD CL
SEPTIC TANK BEVAG[PIT OR PC NO O
PITS AND OR DRAINFIELD O EI000 CO IMP NO JOS NO V
HOUSE SEWER CONN LCTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM C $3 00 O
CONNECT ADDITIONAL BLVD R AFFIDAVIT Ru•!L IUIR!!T RECORD INS" NO DAT[ W
WORK TO HOU{[SEWER O EB OO
OVERFLOW SEEPAGE PIT GRAINFIELD
EXTN CESSPOOL ORYWELL MA NHOL[O ES 00 d
ALTER REPAIR OR ABANDON HOUSE
HWY OR R WIDENING Z
SEWER OR DISPOSAL SYSTEM C {]00 [TAT[ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE AMROVAL
OWNERS PERMTf s z o0 CHARGES
Z,AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMCD CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWdDAT[ INSPECT RSaIONATURa
SIGNED THIS DAY GIB_ ROYALS l
OWNER r�l�J NEW HOUSE SEWER ,J
OWN R.
WNRS AGENT
i�
CONNHT ADDITIONAL
ADDRESS SUILDINCG OR WORK
SEPTICI HEREBY ACKNOWLEDGE THAT I HAVE READ THI[ APPLANDIOR
AND/OR
TANK BEEP PIT(S)
AND STATE THAT THE ABOVE IS CORRECT AND AGR EK
TO �OR DIIAINFI[LD
WITH ALL COUNTY ORDINANCES AND STATE LAWS RE
PLUMBING AND SEWERS POOL ❑ ORYW[LL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTEREDR REPAIR SEWER OR
LICENSED AS REGU IRED BY LOQ ANGLES COUNTY AND AGE DISPOSAL SYSTEM
CALIFORNIA OR T I AM THE LEDAL f$II����MYV)}JJJNNrrr����IN OF AND ONNHCT PLUG AND
R[BIOLINABEOQICRIBEDTIAL OP RTHOUSE SEWER
STOP P� NFILL SEPTIC TANKS PITIS) ❑ CESSPOOLS
VA],IDAT1O� ROBERT A WOOD
CN M o cAeH SUPERVISING MECHANICAL ENGINEER
:.lAc4 2 6 a� tUS j 1 0 D 7.00"