HomeMy Public PortalAbout5336 ZADELL AVE_Sewer_9/8/1961_CONNECTION TO PUBLIC SEWER 24650 INSERTS
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TeA�a�Ia6420 APPLICATION FOR PERMITt'
COUNTY OF LOS ANGELESEWER----SE WAC E DISPOSAL ..�
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DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION ADDRESS } � ,
0 A. LAMSIE, County Enginoor _
ILL$AM A, JENSEN, Eup't of 8nilda'nq LOCALITY
ARES?
F
OR APPLICANT TO "ILL , � ' C OSS ST. � '--� .�
LEGAL -.., - ry
-vw'a .v " Oi
DESCRIPTION LOT N0.
Blaocx 'TRACT
I NO.OF BLDGS. -
SIZE OF LOT ' 'g NOS'd ON LO - CITY TEL. NO.
USE OF
BUILDINGS " ."" DISTRICT NO. GROUP BK PG MAP PROCESSEDay
CONTRACTOR d
ADDRESS , p, 9 = CONNECTION DATA
CITY ,00 TEL.NO s:�..7aSTATION J ( '- DEPTH 7y . `•-.y+`.yam°"
e STATE MANHOLE REFERENCE'
r i UPPER
REGISTRATION NO. `� '1 COUNTt�' . I,.
NO� DESCRIPTION OF WORK r- FEE`
' HOUSE SEWER CONNECTING TO II r
PUBLIC SEWER C� $3.00 i s' TYPE OF CONNECTION LENGTH FROM. v
SEPTIC TAYR SEEPAGE PIT OR � Y. CURB P L. M.L.TO P.L. 'y
PITS AND`OR DRAINrIELD @ $3.00 - - -
OVEiFTOW SEEPAGE PIT, DRAIN.FIELD _ -
EXTN..CESSPOOL DRYWELL @ $2.00
Q LAS SFWt#COM N! Cr c'lr TO P.C.N®.
PRIVkfFS DISn'IIAL SYS M @ $1.00 _Co.ia'!P. N0. � i � JOB N0. �
GO RK T I0'V BLDG.OR TRUNK P'cR$RIT
WORK ROAD PERMIT NO. Q
OR{TO HOUSE NAL
4VFR C� 59,00
A�lE PAP 911 AEANDON HOUSE, j SATE ENCROACHMENT - W
SEWER OR WS:OSALSYSTEM $1,00 PEP,P,4[i N0. 0
INDUSTRIAL
--•--� � WASTE APPROVAL _
{{ ...a CHARGES
OWNETS PERMIT $ 1 2 00 COP{NECTI011i CHANGE EEE
AUTHORIZATION I TOTAL FEE I ti J F- _REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEPEIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE �INSPECTOR'S SIGNATURE_
TO THE PUFL!C SEINER. -� -^- -
SIGNED THIS DAY OF ,�l Of
f9- NEW HOUSE SEWER
OWNER IADDITIONAL
OWNERS AGENT -BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP..PITS)
AND/OR D.RAtNFIELD
I HLCREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL F-1 DRYWEL.L !
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLU.IRBING .AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY. HAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS RKU,..ED BY LOS ANGEL FS COUNTYL AND STATE OF ABANDON HOUSE SEWER
CALIFOtZNIA T AT I AM THEL AL OWNiER.OF THE ABOVE
DESCRIBED SiD TIAL PROrERTY f �ACKF'ILL SEPT!C TANKS I.J
EEP.PIT(S) CESSPOOLS
SIGNtATUR ..
OF PERMITTE
�g VALMATI04 ROBERT A. WOOD
CIL X.O. CASH.;-r` SUPEaRVI-5ING WIECI-IANICAL.FNGINEE.R
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