HomeMy Public PortalAbout8624 WORTHINGTON DR - Sewer - 1960-06-06 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, CountF En neer
CASSATT D. GRYPFIN, Supt of Buildiag LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL a--- .
DESCRIPTION LOT NO. j OWNER .
BLOCK TRACTMAIL
ADDRES
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF —17-1 IMURNERT29cm
BUILDINGS DISTRICT NO.I GR Ua MAPP6 PROCESSED BY
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CONTRACTOR
ADDRESS CONNECTION CONNECTION DATA
CITY TEL.N0. STATION > " ' ✓ -_DEPTH
r °TATE MANHOLE REFERENCE '? U
REGISTRATION N0. tf COUNTY - .� .,r LOWER,<<
No. DESCRIPTION OF WORK FEE -
f HOUSE SEWER CONNECTING TO a �
T PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION - LENGTH FROM
PITS AND/OR DRAINFIELD @ $9.00 Y. CURB 'P L. M.L.TO P.L. -
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.. CESSPOOL.DRYWELL ___@_$2.00
HOUSE SEWER CONNECTING TO .N .
PRIVATE DISPOSAL SYSTEM @ $t.00 CO.IMP,NO. d P.C4iNe0:
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT NO.
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 I TOTAL FEE REIMBURSEMENT FEE
I HAVE DATE ACON-
TRACTORATO CIONNECT THE ABOVET DESCRIBED EXISTWITH THE IINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS—DAY OF19� NEW HOUSE SEWER
OWNER.OR I - CONNECT ADDITIONAL
OWNERSAGENT.- ,9l .,i,d � BUILDING OR WORK -
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAV£ 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
WER
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) CESSPOOLS
OFPERMITTE
/"-'YAMATION ROBERT A. WOOD
jYCL y 0 C"x SUPERVISING MECHANICAL ENGINEER
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