HomeMy Public PortalAbout8603 WORTHINGTON DR - Sewer - 1960-07-08 3808 D
8.88 APPLICATION FOR PERMIT -
:8808
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 40
ADDRESS
JOHN A. LAMBIE, Count Engineer
CASSATT D. GRIFFIN, Sup't of Building LOCALITY i
NEAREST
FOR APPLICANT TO FILL IN CRoss ST.
LEGAL /
DESCRIPTION LOT NO. J OWNER
BLOCK TRACT MAIL
ADDRESSL
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR "IeP
ADDREsS a CONNECTION DATA
CITY TEL.NO. STATION '% DEPTH
REGISTRATION NO. STATE MANHOLE REFERENCE COUNTY �" ; 1 L LOWER
NO. DESCRIPTION OF WURK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION�% ``a LENGTH FROM y
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 -.g - .r'' P.C.NO. -
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. ' '� " JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ Z 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 'eqf 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 OF 19— NEW HOUSE SEWER
- OWNER OR mrd') F-�' CONNECT ADDITIONAL
OWNERS AGENT J - BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
) 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 l AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY„ BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERMITTEE
F
'VALIDATION ROBERT A. WOOD
% y,peg SUPERVISING MECHANICAL ENGINEER