HomeMy Public PortalAbout5325 ZADELL AVE_Sewer_1/27/1958_ 16Ae42D
5 a Z.-663!1.515 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHNA. LAMUN-1
BIE, COy N .ER EG;NF
'E
R
CASSATT Q. GRIc FI;t, 5'jP T OP BUILDING
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO, OWNER
MAIL.
BLOCK 'TRACT' ADDRESS
,NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT No. GROUP MA P
.R PG
CONT
L
ACTO
CONNECTION DATA
ADDRESS
STATION
CITY NO..�
MANHOLE REFERENCE
2t
TATE (LOWER-S
REGISTRATION NO. I/ COUNTY
NO. DESCRIPTION OF tVORK FEE
TYPE OF CONNECTION LENGTH FROM
H-Q U-S E-SEWER- _CO_N CONNECTING,'TO
PUBLIC'SEWER @ $3-50 CURB P., M . TO
SEPTIC TANK.SEEPAGE PIT OR
PITS AND./OR.DRAINFiELD $3.00
i
V R FLOW SEEPAGE PIT, DRAINF15LD P C. NO.
EXTN_CESSPOOL,DRY7,Ei.L,-M,ANHOLE ((v $2. CO. IMP, NO,
I S NO
HOUSE SEWER CONNECTING1'0
PRIVATE DISPOSAL SYSTEM ((-Z $1.00 1 )RUNK PERMIT NO, ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR
I STATE ENCROACHMENT
WORK TO HOUSE SEWER $i.00 PERMIT NO.
T-
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL,SYSTEM 0, s i.co VJA$TF APPROVAL
_7
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT
_00-
AUTHORIZATION TOTAL FEE - REIMBURSEMENT FEE.
L
HAVE AT 'PIS DATE A CONTRACT WITH THE HEREIN NA14ED CON- APPROVALS DATE INSPECTOR'SS-IGNATURF
IACTOP TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
THE PUBLIC SEWER, T I NEW HOUSE SEWER
.�41 �11- �se —
SIGNED THIS D,4Y OF 19CONNECT ADDITIONAL
OWNER OR EUILDING OR WORK
OWNERS AGENT
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAJNFIELD
REPY ACKNOkYL6
G THAT I HAVE READ THIS APPLICATION CESSPOOL(_i D
AND STATE THAT THE' OVE 15 CORRECT AND AGREE TO COMPLY RYWELL LJ
WITH ALL COUNTY DINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. S EN AG_ DISPOSAL_- SY��_1k
1 HEREBY CT'RTIFY ThAT ; AR PROPERLY REGISTERED AND/OR _
LICENSED AS REQWRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM R THE ABANDON OWNER OF THE ABOVE AB� ON-HOUSE SEWER
N
DESCRIBED RES]DtITLkL P'OPER T Y- BACKFILL SEPTIC TANKS
T C -P-
QLS E
SEEP,PI,IS) —I ESS ) :,
SIGNATURE
05 PERMITTEE
OHN A. LAMWEI COUNTY ENGINEER ,.�VALIDATION ROSER'T A. WOOD, CHIEF PLEIG. INSPECTOR
) 01 CASE
4
c4�4 2 7 4 A .5,C)
Aev