HomeMy Public PortalAbout5310 ZADELL AVE_Sewer_7/31/1949_ APPLICATION FOR PERMIT 1
�sos•e•se COUNTY OF LOS ANGELES
SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRESS �.
IOI�t A. LAMSYE. Corea �` 7-
TEL,
t7 EngineerCASSATTD. GRIPM.Snp't of Building FOR APPLICANT TO FILL IN
LEGAL L p
DESCRIPTION LOT NO. 1 OWNER rr/ {�"A.MAIL
r.4 BLOCKTRACT ; �s ADDRESS ' , d d� �.4 !NO.OF BLDGS.SIZE OF LOT (;''6 $ NOW ON LOT - CITX > 1 e. >>r a, N ✓� �R
USE OF
BUILDINGSf i71 s� DISTRICT 110. GROUP MAP PROCESSED BY
BIC PG 9
CONTRACTOR -., ✓f
ADDRESS � r � � y , .�
CONNECTION DATA
CITY % V TEL.NO. d
a, f_:, STATION .a�� 1 9 s"`3 DEPTHSTATE
✓ I �,
REGISTRATION NO. COU NTY MANHOLE REFERENCE r UPPER
NO. DESCRIPTION OF WORK FEE ��I � � ✓'• LOWER
HOUSE SEWER CONNECTING TO �}+
PUBLIC SEWER @ $3.00 —
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTIONS LENGTH FROM
_PITS AND/OR DRAINFIELD @ $3.00 Y. CURB ¢ P L. MA,TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,C.ESSPOOL.,DRYtk£LL,MAf6HOF,E @ $2:00
NOUSE SEWER CONNECTING TO P.C.NO.
ARIVI.TE DiSP05A_SYSTEM @ $1.00 IMP,H0. ' er�ti -s` 70B N0.
CONNECT ADDITIONAL BLDG.OR —CO.TRUNK PERMIT N0. I ' ROAD PERMIT NO.
SNORK TO HOUSE SEWER C $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1.00 - PERMIT NO. -
vINDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
e.
AUTHORIZATION TOTAL FEE j' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SM-NATURE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK 1
SEPTIC TANK,SEEP,PITS)
ADDRESS _AND/OR:DRAINF.I£i-:D _ I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL(j
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. _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 T�M ABOVE --
DESCRIBED RESIDENTIAL,PROPERT , ,r --- .BACKFILL SEPTIC TANK'S[I
i
SIGNATURE SEEP.PIT(S) 0 CESSPOOLS El
a�%r �
OF PERMITTE oa y
(fie `1TALIDATIOlk'__. t ROBERT A.WOOD
Cr.. H.e. CASH SUPERVISING MECHANICAL ENGINEER
9