HomeMy Public PortalAbout6330 SALTER AVE_Sewer__ CE808 °I i-y7 -�-
CE80APPLICATION FOR PERMIT
8 _
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
IOHN A. LAMSIE, County Engineer ADDRESS ^_ _�
CASSATT D. GRIFFIN, Supt of Building
LOCALITY
FOR APPLICANT TO FILL IN CROSNEAR sr. ,__
LEGAL ------ —
DESCRIPTION LOT N0. OWNER
BLOCK TRACT MAIL -- ---- —
_ADDRESS _ ___ __
NO.OF BLDGS. —
SIZE OF LOT NOW ON LOT CITY TEL.N0. .
USE OF
BUILD=NGS _ DISTRICT NO. GROUP MAP
CONTRACTOR —r'�
ADDRESS r ,; CONNECTION DATA
CITY ��� W _ TEL N0. STATION t' - 1-' �'"-.., DEPTH ---t"
STATE MAN14OLF REFERENCEf UPPER
REGISTRATION NO. i _ .' J r Tj COUNTY r Z , . LOWER
N0. 1 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER � $.3�0 � / ,� L
SEPTIC TANK,SEEPAGE PIT OR TYPE OFpavlft
7ION LENGTH FROM ry
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB- _ P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD - —k,-
f .EXTN_CESSPOOL,DRYWELL,69ANH0LE @ $2.00
HOUSE SEWER CONNECTING TO ./ P C NO
PRIVATE_DISPOSAL SYSTEM @ $1.00 CO.TMP,N0. ,A-': „$ �,' JOB N0.
CONNECT ADDITIONAL BLDG,OR — -
WORK TO HOUSE SEWER TRUNK PERMIT NO. ROAD PERMIT NO. �
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM $1.00 I STATE ENCROACHMENT
PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $_ 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE �( I(1-" REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON•
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS --_..DAY flF_.— y g_i NEW HOUSE SEWER
OWNER OR /-. CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PI'f(S)
ADDRESS—.__.___ _ __.__. _AND/OR DRAINFIELD
I HEREBY ACK.NOWLFDGG THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWEI.L.0
WITH ALL COU14TY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REG-ISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND �
CALIFORNIA OR THAT. I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER I.
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP. PIT(S) []CESSPOOLS
OF PERMITTEE
'VALIDATION ROBERT A. WOOD
Cx. M.0. CASH SUPERVISING MECHANICAL..ENGINEER