HomeMy Public PortalAbout8609 WORTHINGTON DR - Sewer - 1960-07-08 BA842D APPLICATION FOR PERMIT - -
ESOB 8.59
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILD sG
DO
A BE
JOHN A. LAMBIL Count. Engineer
CASSATT D. GRIFFIN. Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK e MAIL
ADDRESS
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT N0. GROUP BK MAP PG PROCESSED BY
CONTRACTOR 1 1
ADDRESS CONNECTIO DATA
CITY TEL.NO. STATION 1 ) DEPTH
STATE MANHOLE REFERENCE ✓
REGISTRATION NO. Pr
COUNTY a LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTI6 LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR - Y. CURB 4P.L. '0 M.L.TO P.L.
PITS AND/OR DRAINFIELD @ 53.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSP60L.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.G.N0. »-�``-'
PRIVATE DISPOSAL.SYSTEM @ $1.00 CO.IMP. NO. JOB NO
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0,
WORK TO HOUSE SEWER @ SI.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO..
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL. FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE 1NBPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR i
J J CONNECT ADDITIONAL
OWNERS AGENT ;-�-�~ BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT FLAG 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 SEEP.PIT(S ❑ CESSPOOLS
OF PERMITTE
:-'`',VALIDATION ROBERT A. WOOD
y
CIL R.0. CASH SUPERVISING MECHANICAL ENGINEER