HomeMy Public PortalAbout5405 SANTA ANITA AVE_Sewer__ r
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�eAeuD APPLICATION FOR PERMIT
COUNTY OF LO$ ANGEL SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION mulamika
WmA 1MMM Cotm En ADDRKAV O j
W�TraLll JL IGEN, Sup'[ of Budldiaq
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
D[ECRIPTI ON LOT NO. OWNER
MAIL
■LOCK TRACTALIDR[B � f
NO. OF ■LOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO. i4lf _
6110
UB[ OF DIGTRICTjJ2 f MAP PROCtI eY
BUILDINGS
BK PG
COIIT1lA CTOR -15'0
O CTION DATA
STATION DEPTH
CITY L TIL. NO
STAT[ MA OL[R[FE R[NCL UPPER
RdOIrTRATIPH NO. - COUNTY LOWER
NO. DESCRIPTION OF WORK FEEOF CONNECTION WGTH FROM
HOUBB■EWERCONNFCTINQ TQ Y. CURB F.L. M.L.TO P.L.
PUBLIC SEWER SB.00 P.C.No. O
BKPTIC TANK,B[ P O[PIT o4R CO.IMP.No. JO■NO. V
PITS AND/OR pKAINFILLD * SId.00
HoUEF SEWER CONNECTING TO TRUNK PEIRMFT NO. ROAD PERMIT NO. fx
PhIVAY[DISPOSAL SYSTEM SB.00 O
CONNECT ADDITIONAL■ OG.OR AFFIDAVIT I •A�II RECORD.INSTR.NO. QA
WORKTO HOUSE SEWER •7.00
OVERFLOW 811"AQLPIT,DRAINFIELD
L
EXTN.,CEB*POO ,bRYW LL_MAN HOLE 0 98.00 H
ALTER'R PAIR O A NOO OU HWY.OR ST IDLNINQ Z
6[W[R OR DISPOSAL SYSTEM 5.00 STATE ROACHMKNT
PERM HO.
N •TRIAL
APPROVAL
CHARGES
OWNERS PERMIT i 2 00
CONNECTION CHARG[F[S
AUTHORIZATION TOTAL FEE
.1 HAVE AT THISDATE A CONTRACT WITH THL HEREIN NAMLQ CON- RLIMBURf BMEN7 FIR
TRACTOR TO CONNEHI
CT T [ AEOV[ DSCRISID W.AIsTING DWLLLING I�
TO THL PUBLIC SEWER. APPROVALS DATE INSPECTOR'•SIGNS [
SIGNED THIS DAA' OF tO_
OWNER ON NEW 1i0Uf[■EWER
OWN x"AGE HT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
I HERESY ACKNOWLEDGE THAT I HAVE READ AND/O
THIS APPLICATION 7ANK,SEEP.PIT(S)
AHD STAT[ THAT THE AEOV[ If CORRECT AND AGR[[ TO COMPLY AND/ R DRAINFI[LD
WIT?I
ALL COUNTY ORD I NA NC[S AND SE TATLAW■ REGULATING CESSPOOL d DRYW[LL ❑
PLUMBING AND sKWERS,
I HEREBY CERTIFY THAT I AM PROPERLY REGIBTER[D AHD/OR ALTER,REPAIR.SEWER OR.
LIC[N•[D A■ RQOOIRlD BY LOS ANGLL COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO DISC NN[CT PLUG AND
RESIDE IN, THE AEO D[BC IE[q RESIDENTIAL PRO]-LRTY. ABAHbON HOUSE SEWER
SIGNATURE be
E
OF PERMITTEE AGKFILL S[PT1C TAN Kf ❑
S[4P,P17,17 LJ 4Esa ro0LII
AMATION R013ERT A. WQOD
K.
M.
0, GSH SUPERVISING MECHANICAL ENGINE"
LAC08796Z8 JAN 141 0 D 5.00- 8