HomeMy Public PortalAbout5302 ZADELL AVE_Sewer_11/13/1964_ ,E808 10-153
A6 2D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Sup't of Building
LOCALITY_____
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NE�A�R EST
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CROSS ST.
FOR APPLICANT TO FILL 7N
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'W OWNER
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DESCR '11 ON LOT NO.
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BLOCK TRACT ADDRESS
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N I_Y
SIZE OF LO! NOW 0 LOT c I TE:L, NO.
USE OF
DISTRICT NO. GROUPPROCESSED BY
MAP PG
CONTRACTOR
CONNECTION DATA
STATION """' ✓' ,r DEPTH
CITY TL
LJ STATE MANHOLE:REFERENCE If
REGISTRATION NO. COUNT" wER
NO._ GESCRIPTIOhv &F-WORK
TYPE OF CONN
—------ FEE LENGTH FROM
Y. CURB L. M.L.TO P,L.HOUSE SEWER CONNECTING TO
P.C.NO,
SFP7;CTANK,SEEPAGE PIT OR IIM'P� No. JOB NO.
s PITS AND/OR DRAINFIELD $10.00 _co_
HO�dSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PrjVAYE DISPOSAL 5YSTE41 S3,00
0
WORK T
AFF_i&AVITI WAIVER? xIsVMENT RF RO. 1. 5 R.NO. I DATE
CONN F CTADDITjONAL SLOG.OR O HOUSE SEWER @
OVERFLOW ISE EPAGE FFT.DRAI WFIELD
EXTN,,CESSPOO'-,DRYWELL,M.ANP.OLE:a $5.00
-- _----- — i HWY. OR ST.WIDENING
----.ALTER
S � .R�PA R R ABAND N HOLE
�
3E�
Ea. P SAL SYSTEM
$3.00 STATE ENCROACHMENT
PERMIT NOL
—------- INDUSTRIAL
WASTE APPROVAL
CHARGES
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OWNF,R'S MIT CONNECTION CHARGE FEE
AUTHORIZATIONF-TOTAL FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _EIMBURSFMENT FEE
TRACTOR TO CONNECT THE A13OVE DESCRIBED EXISTING DWELLING
TO P DATE INSPECTOR'S SIGNATURE
THE UB�,IC SEWER. APPROVALS
SIGNED THIS DAY OF __-,�
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONN EST ADDITIONAL
BUILDING OR WORK
00 —-----
SEPTIC TANK.SEEP,PIT(S)
HEREBY ACKNOWLEDGE 'THAT 1 HAVE RLAD THIS APPLICATION ANC/OR DRAZNFiELD
TRACTOR R
I
W
A
4
AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALI- COUNTY ORDINANCES AND STATE LAWS REGULATING
P L, ING AND SEW RS,
PLUMB E CESSPOOL DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
I
LICENSED AS REQUIRED WY LOS ANGLES COUNTY ANF) STATE OF SEWAGE DISPOSAL SYSTEM.
A
___N_ F
C A16 INTEND To NECT PLUG AND
AL'FORNIA IHAI�101 THE LEGAL OWNER .1,
'N THE A� SEWER R
RESIDE; RE
at S r1l _RT-'
ABANDON HOUSE WE
SIGINAm RE B CKFILL SEPTIC TANKS
OF PE'RM)TT
FE_ SFEr.PIF(S) 0 CESSPOOLS
VALIDATION- ROBERT A. WOOD
CK. M.0, CASH SUPERVISING MECHANICAL ENGINEER