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E-660 �► APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE .DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAI4tBlE, COUNTY ENGINEER ADDRESS
CASSATT D. GFzdF'FiPd, Sua'ToF 6'UtLDi»c LOCALITY.
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FOR APPLICANT TO FILL IN NEAREST
-_ _CROSs STTLEGAL
DESCRIPTION LOT NO -t;3� OWNER_ f _
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BLQCY,'-- TRACTa ,J xJ MAIL
--ADDRESS
NO. OF BLDGS.,
SIZE OF LOT
NOW ON LOT
USE OF
$iUILDiNCS,---
<' -*;': '�.. DISTRICT NO. .n.: GROUP MAP
BK PG
CONTRACTOR
- y- CONNECTION DATA
ADDRESS
STATION DEPTH
,.x _
CITY s.=, ! �,L. NO. — - --- -- -.---_._
MANHOLE REF'FAF'NC� UPPER
I] STATE LOWER
REGISTRATION NO. COUNTY -NO. ! DESCRIPTION OF WORK FEE .—_...--.-----.—
_...-_F .---------- -- _-------.------- ---. TYPE OF CONN--CTIO- LEN 07 Ft. rROM
t 14OUSE SEWER CONNECTING TO Y, CURB P.L.
PUBLIC SEINER $3.50� -----..-..-.-.-----------------
SLPIIC TANK SEEPAGE PIT OR ----I —
PITS AND/OR DRAINFIELD _ _ (Gil $3.00
UUERF'LOW- S-EEPAGE PIT.DRAINFIELD —i-- C. NO.
EXTN.,CESS POOL,DR WELL.MANHOLE 4, $.Z,QO_; I CO. TMP N0. !OB NO,
HOUSE 5k44FP CONNECTING TO I -�----
j PRIVATE DISPOSAL SYSTEM U $I..00 TRUNK TFRMIT NO. ROAD PERMIT NO.
V CONNECT ADDITIONAL BLDG.OR i STATE ENfROACHMENi
WORK TO HOUSE SEV;`R (.1
--------- $1.U C. PER MIT NC.
SEALTER,REPAIR OR ABANDON HOUSEINDUSTRIAL
ShbVER OR D[s PC'SAL S STEL t i.0
CHARGES
- -___ -- --- I- - _--- CONNECTION CHARD FEE
OWNER`S PERMIT c i vJ . _ — --------- ------- -
----- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
1 p
I HAV.c. AT THI^ DATE 4 CONTRACT , �, GN- APPROVALS D,9 TE. ;1N 1''E CTOR'S SIGSJR7URE .
T R3CT N,7}1 THE k3�RE�44 NA�tkD C
TRA'TOR TO l.Ohb h-/'[ I,lL ABOVE DkSGR13ED EXISTING Dw .LL.N&
,0 '-HE pusl,zc SEWF.R. ,i- .,_ NEW HOUSE SEWER
SIGNED Tt is c-zNECT
- it —
1 i
0!"lN R OR f tt i dr,` BUILDING OR ORNA.
0 W N F R 5 Ac, N T–'
--
:-_ SEPTI C I NK,SEEP, PIT(S
f a AND/OR DFA NFICLD
+ HEREY CK' J1(LED E THAT I HAVE READ T}IS APPLICATION
„1�yT-s CESSPOOL Lj DRiWELL ]SCRV7 AND A PPI(
..-. __.
V
h171H ALL COUNTY ORWNx,aCF, , AND STATE LAAS REGULATING ALTER,.REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM '
' HERE.Y C R --'i THAT 1 AM P JPERL* REGISTERED AND;'GR RI CONNECT PLUG AND
--� -
I
L105N51=U AS. REOUiRED BY LOS AN- ELES COUNTY AND STATE OF S CONN CT PL AND
CALIFORNIA OR THAT I AM -ihc LEGAL OWNER Or, 'THL ASOVE ---_._ :.__.._DESCRIBED RESIDENTIAL PROPERTY. 3 ., BACKFILL SEPTIC TANKS -
"' r.d• SEEP PIT+s! L, OESSPGOLS E
SIG
MATURE I
OF PERMITTEE
JOHN A. LAMBIE.COUNTY EKb NFFR � VALIDATION _ ROBERT A. WOOD, CHJE;- PLED. INSPECTOR
CK. Id.0. GASH
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