HomeMy Public PortalAbout5311 ZADELL AVE_Sewer_9/26/1960_ t
b � APPLICATION FOR PERMIT 1
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
T'EPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FBILDING ` F�
DRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup't of Building
LOCALITY r
IRES—
FOR APPLICANT TO FILL IN oss
LEGAL ?�
DESCRIPTION LOT NO f'`{ OWNER
HAIL
BLOCK TRACT,/F�' ;'Y� _ADDRES3_" ----,--
SIZE OF LOT " -;� "' --NO,OF BLDGS.
! `,^, '_NOW ON LOT �\ CITY, y TEL.NO.
USE OF
_ - O GROUP I MAP
CONTRACTOR --_ DISTRICT N T BK t, PG
s
ADDRESS i? CONNECTION DATA
CITY %.; TEL.N0. STATION// •J ,� DEPTH
`STATE MANHOLE`REFERENCE ,+'�
REGISTRATION NO. s � � i J COUNTY ~ /' F•' LOW Eft`%
No. DESCRIPTION OF WORK FEE -
f HOUSE SEWER CONNECTING TO ;! -
`-
PUBLIC SEWER _ @ 3.4510
'- - 3.4510TYPE.OF CONNECTION LENGTH FROM •^1•
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P•L: M•L_TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO p,C.N0,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP.N0. F '7" JOS NO.
CONN F,CT ADDITIONAL BLDG.--OR
WORK TO HOUSE SEWER _ _ @ $1.00 TRUNK PERMIT NO ROAD PERMO-NO.
ALTER, REPAIR OR ABANDON HOUSE -'
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT _
_PERMIT NO. -
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OWNER'S PERMIT �j 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
REIMBURSEMENT F£E
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS FATE I INSPECTOR'S SIGNATURE
TO THE PUBLIC SEEWERr
SIGHED THIS DAY OF " —1 9 NEw HousE BOWER
OWNER OR CON:NECT ADDITIONAL 1 `�
OWNERS ACE_NT : :1 _BUILDING OR WORK
i - "� x SEPTIC TANK,SEEP,PIT(S)
ADDRESS L._.` p ----_, =y-_-., AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL.0-_DRYWELL❑ _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTEREDAND/OR _SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER _
DESCRIBED RESIDENTIAL PROPERTY, -a. BACKFILL SEPTIC TANKS❑ T
SIGNATURE �, SEEP. PITS) El CESSPOOL>< L-
`
OF PERMITTEE ��`,� " '
DF VAMDATION-- ROBERT A. WOOD
CK. e.o, CASH SUPERVISING MECHANICAL ENGINEER
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