HomeMy Public PortalAbout6313 SALTER AVE_Sewer__ fBA08-8 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ,
JOHN A. LAMBIE, County Engineer ADDRESS ,.y r_____.�_.�.._.
CASSATT D. GRIFFIN. Supt of Building LOCALITY R µ -
NEAREST
FO, ,APP:rIC T TO F'I W CROSS ST, _-- _-_ _
LEGAL r _
_DESCRIPTION LOT NO I-ej y,S - ,' OWNER a� _�- 4Y �� p,»
BLOCK TRACT / MAIL
-
.; r ✓ x.-ADDRESS ��.v_ _ _�_
NO.OF BLDGS, _ 1
-
SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS D STRICT`n GROUP MAP PROCESSED BY
-- — � BIC P
CONTRACTOR
ADDRESS - CONNECTION DATA
CITY TEL. NO. STATION DEPTH
�] STATE —hiANHQLE REFERENCE �UPPc:R
REG( TRATION NO COUNTY LOWER
NO. i DESCRIPTION OF WORK FEE —
HOUSE SEWER CONNECTING TO -. i F�. �.•� / ,
PUBLIC SEWER @ $3.00 c - i 2
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFiEI.D Oc $3.00 Y. CURB P.L. M,L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,D_RYWELL,MANHULE Q $2.00
HOUSE SEWER CONNECTING TO P.C. NO.
PRIVATE DISPOSAL SYSTEM $1.00 CO.IMP.NO. _ JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER R $1.00
.ABANDON HOUSE STATE ENCROACHMENT
SEWER _ @ $IAO PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OIL'S PERMIT ff 2 i 00� CONNECTION CHARGE FE&
AUTHOMZATION TOTAL FEE f REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON, a APPROVAL DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. —
SIGNED TFJS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING.OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _CESSFOOL[I DRYWELL 0 _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWER$. SEWAGE DISPOSAL SYSTEM _
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT. I AM THE LEGAL OWNER OF THE ABOVE — --
DESCRIBED RESIDENT( ROPERIY p BACKFILL:SEPTIC TANKS
SIGNATURE r' SEEP. PIT(S) [I CESSPOOLS[I
� �+" � � •�"ro
OF PERM ITT E117,11
E
>< TIO " ROBERT A.WOOD
!1.
Q. CAst% J SUPERVISING MEC43ANICAL,(ENGINEER
';eos- APPLICATION FOR PERMIT"
»>eea �� COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ABUILDING " J
JOHN A, LAMBIL County Engineer DDRESS r
CASSAIT D. GRIFFIN.Supt of Buitds`aag LOCALITY A k
NEAREST
FOR,I
,�PP.14QViT ,TJ1�L
LEGAL
DESCRIPTION OT Na s OWNER d sp�4
BLOCK TRACT ,y � .. ADDRESS .)
SIZE OF LOT I� r1DW ON LCT t" CITY = r kF
USE OF
BUILDINGSDISTRICT NOGROUP MAP PROCESSED BY
r
BK PG
CONTRACTOR ` .
ADDRESS Y CONNECTION DATA
CITY TEL.NO, STATION DEPTH
STATE MANH01 REFERENCE UPPER
REGISTRATION NO. (� COUNTY LOWER
NO. I DESCRIPTION OF WORK FEE a -c
HOUSE SEWER CONNECTING TO ✓-�. —
SEPTIPUBLIC SEWER @ $3.0£9 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,DRAINFSEEPAGIELD
PIT OR Y. CURB P.L. M.L.TO P.L.
PITS ANDlOR DRP.INFIELD � $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO % P C,NOo`
PRIVATE DISPOSAL SYSTEM a $1,00 CO,IMP.NO. p� 3J�0---8,#ff
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO.'' -ROAD PERMIT NO.
WORK.TOHOUSE SEWER a $1.00 F�
R
ALTER, N HOUSE STATE ENCROACHMEft
SEWER R 5-=^" 4"T" @ $1.00 `"�' PERMIT N0.
NDUSTRIAL x'
„HASTE APPROVAV
:CHARGES
OWNWS PERMIT 3 2 OO eaHNEcTION CHARGE FEE
AUTHORIZATION TOTAL FEE I
ll a' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATk, INSPECTOR'S SIGNATURE
TRACTOR To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER,
SIGNED THIS—DAY OF 19— New HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAV% READ THIS APPLICATION C>SSI604❑ BRYWELL[]
AND STATE THAT T14E ABOVE 15 CORRECT AND AGREE TO.COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED ftE5lDE OP° BACKFILL SEPTIC TANKS
SEEP. PIT
(Sj [� CESSPOOLS
SIGNATURE .
OF PERMITTEE
log ( VALMATIOII ROBERT A.WOOD
$6r, Y.4. 6AifIC) SU URVISING MECHANICAL LNGiINBBR
s -1- ,,