HomeMy Public PortalAbout5330 ZADELL AVE_Sewer_9/8/1961_sewer connection 9
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7AG42APPLICATION FOR PERMITj`
�Aeaa® COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION ADDRE Nc �
ADDRESS
ILLIV. LAMPIE, County Engineer
W
ILLIAM A. JENSEN, SuP't of Building LOCALITY _.._.
NEAREST
FO O FILL INCROSS ST. �
LEGAL
DESCRIPTIO1 L0 f �� d �! OWNER
BLOCK. TRACT MAIL
0 ADDRESS
NO.OF BLDGS,
SIZE"OF LOT NOW ON LOT CITY TEL- N0.
IiSE OF ....
BUILDINGS � 1�-TY
STRICT NO. GROUP. MAP PROCESSU"BY
BM PG f
CONTRACTOR _ "=�" � .��'✓",
ADDRESS `yy� - � ^� ��r ,_ CONNECTION DATA
CITYTEL.NO. ) TATION DEPTH
STMANHOLEREFERENCEREGiSTRATIQN N0. l,°� CO / q LOWER
NO. 1DFSCRiPTION OF ARK FE.HOUSE S WER CONNECTING TOUBLIC SFIVER @ $3.00
SEP7IC 7Ai�K,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM`i CONNECTION
P.L. M.L.TO P.L.
PIPS AND;OR DRAINF'IELD @ S3,Q0
OVERFLOW SEEPAGE PIT.DRAINFIELD
EYTN.. CESSPOOL.DRYR/EI.L @ $2,00
HOUSE SEINER CONNECTING TO I ,/ -'` P.C,NO.
PRIVATE DISPOSAL.SYSTEM @ $1.00 I CO. IMP. NO.�1 '� JOB NO.. „
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.,� _ Q
WORK TO HOUSE SEWER C $1.00 U
ALTER, REPAIR OR AB I)EfN HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM fa $
1.U0 PERMIT NO. p
INDUSTRIAL V
WASTE APPROVAL G7
CHARGES
OWNER'S PERMIT 31 `21 00 CONNECTION CHARGE FEE �
AUTHORIZATION TOTAL FRE � �� REIMBURSEMENT FEE
TRAAVE TORATO CIS DATE A ONNECT THE CONTRACT ABOVE DESCRIBEDIEXISTINGAMED CON-
WDWELLING APPROVALS DATE (INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF S9___ NEW HOUSE SEWER
OWNER OR �+' _ CONNECT ADDITIONALI
OWNERS AGENT GV�'� BUILDING OR WORK 4
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE "THAT' THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL r- DRYWELL E7
WITH .ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SOWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY .HAT r AM PROPERLY REGISTERED AND/OR DiSCONNECT PLUG AND
LICENSED AS REQU ED BY LOS ANGELES COUNTY AND STATE OF ABANDDN HOUSE SEWER
CALIFORNIA OR ,A° A7 I AM THE LEGAL_ OWNER F THE ABOVE
DESCRIBED REQ N.kf'�L PROPERTY. BACKFILL SEPTiC TANKS ❑
SIGNATURE f_ ✓ (,,,.�„ S'eEP. PiT.(SD CI CESSPOOLS El
OF PERMIT
F
VALIDATION------ ROBERT A. WOOD
CK. R.A. CASH SUPERVISING MECHANICAL ENGINEER