HomeMy Public PortalAbout8608 WORTHINGTON DR - Sewer - 1960-06-06 BA642D
X808 8.99 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
F
JOHN A. LAMBIE. County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building LOCALITY
EmmaNEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL ) f
DESCRIPTION LOT NO. OWNER_
BLOCK TRACT MAIL
ADDRE
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL..NO.
USE OF
BUILDINGSi - DISTRICT N0. GROUP _ MAP PROCESSED BY
CONTRACTOR _ PG
ADDRESS
_ CONNECTION DATA
CITId_ TEL �r �+ STATION
L r / / y DEPTH
y�.ry' ATE MANHOLE REFERENCE f �-� - UP
REGISTRATION NO. y+f �Y f x L COUNTY d OWER'
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ...�
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION,,—' _ LENGTH FROM J ,
SEPTIC TANK,SEEPAGE PIT OR Y. CURB e"P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00 -
OVE.RFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO. _
PRIVATE DISPOSAL.SYSTEM @ $1.00 CO. IMP. NO. 308-*IO__ , F-
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ SLOD TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER, REPAIR OR ABANDONHOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $
1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OWNERS PERMIT $=21 CC CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I ., I ?-' 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 I9 NEW HOUSE SEWER �e i
OWNER OR `--- ? CONNECT ADDITIONAL
OWNERS AGENT-- �� f BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PITS)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWE.LL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I 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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS ❑
SIGNATURE sp SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTE
VALIDATION ROBERT A. WOOD
11 Y,e. CASH SUPERVISING MECHANICAL ENGINEER
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