HomeMy Public PortalAbout5137 SANTA ANITA AVE_Sewer__ 7BA53 tF:SS.
E APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE,COUNTY ENGINEER _ADDRESS ��le
CASSATT D.GRIFFIN, SUPT of BUILDING - LOCALITYFOR APPLICANT TO FILL IN NEAREST
CROSS ST. L R
LEGAL
DESCRIPTION LOT No, ----- -- OWNER
BLOCK TRACY / MAIL.
---- -- --- --- _ADDRESS - - -- "'-�`—f--
1 f NO.OF BLDGS.
SIZE OF LOT� � F'.NOW ON LOT
CITY -a1' y
USE
UILDDINGS_ DISTRICT NO. I GROUP MAP
BJr� _ B K PG
-_.
CONTRACTOR .
– - — —— CONNECTION DATA - -
ADDRESS
;;;���✓✓� STATION DEPTH _
CIT TEL. N0, _ MANHOLE REFERENCE -—�— - — _—UPPER
STATE ._- .: _ _ LOWER_
REGISTRATION NO. ElCOUNTY
r �,r
No. DESCRIPTION OF WORK FEE `
HOUSE SEWER I � _. TYPE OF CONNECTION — LENGTH FROM
CONNECTNG 70
Y. CURB P.L. M L TO P L _
PUBLIC SEWER @ $3,50 -— -- - --
SEPTIC TANK,SEEPAGE PIT OR
PITS ANA/OR DRAINFIELDoda- $3.00
"— OVERFLOW SEEPAGE PIT,DRAiNFIELD ---�------------ ., P. C,.No, -
EXTN..,CESSPOCL,DRYWELL,MAN HOLE u- $2,00 I CO, IMP. N0. "•. JOB NO.
__iHOUSE SEWER CONNECTING TO '
_P IIVATE DISPOSAL SYSTEM �1 $1,00 I I TRUNK PERMIT NO. 'ROAD PERMIT NO,._—
{ CONNECT ADDITIONAL BLDG.OR 9 STATE ENCROACHMENT •�
f WORK TO HOUSE SEWER C' $ 00 ,?r � . PERMIT NO,
-i ALTER,REPAIR OR-ABANDON HOUSE - ---- .-- ----------
' SEWER OR DISPOSAL SYSTEM � `$9.00 IND TSTR?AL -----`---_-----"----
-S-EWER _ OSAL WASE APPROVAL
CHARGES
---- —_-- --L-_.--
CONNECTION CHARGE FEE
OWNER'S PERMIT a I 00 -- J-- - ---
AUTHORIZATION —TOTAL FEE � � - REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH 'THE HEREIN NAMED CON- APPROVALS DATE 1INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DVIELLING
TO THE PUBLIC SEWER. NEV, HOUSE SEWER
SIGNED THIS_..._ DAY OF_. I9 coxx£c7 koDlrtoNAL I -
OWNER OR BUILDING OR WORK '
OWNERS AGENT SEPTIC TANK.SEEP,PIT(S) -
ADDRESS AND/OR DRAINFIELD .__.—_ --------,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLLI DRYWELLL'-]
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND E AB DISCONNECT PLUG AND ABANDON HOUSE SEWER OF ��—
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE --- ------ ----- -
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. ,,IT($) LJ CESSPOOLS 0
OF PERMITT1 --- --
iOt-IN A. LAMBtE,Court y ENGINEER p"VALIDATION
ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
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