HomeMy Public PortalAbout6317 SALTER AVE_Sewer__ EAAPPLICATION FOR PERMIT
6A 642D42D
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION aUlLDING _ __
ADDRESS
TOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR "PUCPM TO FII.L CROSS ST. r L
LEGkL F OWNER
DESCRIPTION LOT N0. :I.§,y
BLOCK TRACT y,:•:,, ,, ,s ;f% ,H ", MAIL
ADDRESS -
NO`.OF BLDGS.
SIRE OF LOT N0W ON LOT CITY` TEL. NO.
USE DI DISTRICT NO. GROUP MAP PROTSED BY
BUILDINGS �� ? 5 BK PG ' ti
CONTRACTOR T
ADDRESS CONNECTION DATA
t
CITY y / TEL,N0. STATION DEPTH
[[�
STATE MANHOLE REFE'RENCpf UPPER
REGISTRATION N0. s 19 COUNTY
NO. DESCRIWOR".—,T N OFFEE — y LOWER.
HOUSE SEWER CONNECTING TO '
PUBLIC SEWER S3•00 TYPE OF CONNECTCON LI5NGTH FROM `
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO "`" P.C.N0, O
PRIVATE DISPOSAL SYSTEM @ SI.00 CO.IMP.N0. ``� JOB 0:' U
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. 4 6DIPERMIT NO.
WORK TO HOUSE SEWER @ $1.00
° ALTER,AFFAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM Gi $1.00 PERMIT NO. U
INDUSTRIAL - LU
WASTE APPROVAL' ' t�
t+ CHARGES z
OvWNEiR`*s PERI�T 2 00 CONNECTION CHARGE FEE
RtT�V ai3ORIZAJ,iOIV TOTAL FEE 'f L e' REIMBURSEMENT FEE
I HAVE AT ACTOR TO CI
CON-
TRACTOR THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR°S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS DAY OF
NEW HOUSE SEWER
OWNER OR j CONNECT ADDITIONAL
OWNERS AGENT �" ' '' �"s:fir �`�''' a,..r,� BUILDING OR WORK
ADDRESS " ,._�)%7`� f,2---- SEPTIC TANK.SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
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 ABANDON.HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT AL PROPERTY- - BACKFILL SEPTIC TANKS LL
SIGNATURE - `/- SEEP.PIT(S} [I CESSPOOLS
OF PERMIT"
r'"-VAMATION ROBERT A. WOOD
Gsc.;, Y.o. CASH SUPERVISING MECHANICAL ENGINEER
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