HomeMy Public PortalAbout5703 OAK AVE_Sewer_5/23/1958_G425&E-6O
S APPLICATION
&
DI I-3$ IVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles
JOHNIII. I
L.u6.nlinW,.,iill
HN A. COUNTY NEER
T D. GRIFFIN DING
�I, ill N
FOR T TO IN
LEGAL J� j�
DESCRIPTION LOT NO. � r+
BLOCK TRACT
)�� ` Z
��Sf/� N0. OF SLOGS.
SIZE OF LOT
NOW ON LOT
USE OF
CONTRACTOR xZ'77
_ ;?401,7`
ADDRESS
CITY f / { TEL. N0.
REGISTRATION NO. /%�GIR� STATE
El COUNTY
No. DESCRIPTION F WORK FEEL
rIPHOUSE SEWER CONNECTING TO
PUBLIC SEWER
Q $ 3.501 3 4;-()
ISEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $ 3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE 0 $ 2.00
HOUSES
EWER CONNECTING TO -
l PRIVATE DISPOSAL SYSTEM @ $ 1.00
CONNECT ADDITIONAL BLDG. OR I �—A-
_ WORK TO HOUSE SEWER Q $ 1.00
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 0 $ 1,00
FOR PERMIT 1
SEWER -SEWAGE DISPOSAL
BUILDING
ADDRESS
NTY
NEAREST
``NEAREST
qOSS ST
or OWNER
MAIL Y%. _2-i ii'..Y,_
ADDRESS_/��''yt�l_
CITY �/� A TEL NO. T Ne
a.unTRI �,T NO. GROUP
rf�1i.I.Fln� a i,i ieGROUUPP ""�
_
DISTRIC'
MAP l
EK
KPG
CON 21
DAT /a 6
STATION -'S7-� 7 7 U DEPTH • Ce '
MANHOLE REFERENCE /.1 2
TYPE OFSOMyZWON LENGTH FROM
Y. `CURB'!• P.L. M.L. TO P.L.
CO. IMP. NO. ' P. C.
Ro'P. NO.
STATE ENCROACHMENT
PERMIT NO.
INDUS JAL
WASTE -APPROVAL
CHARGES
ER
:..SVA
OWNER'S
A
PERMIT
CONNECTION CHARGE FEE
s I 11 Do
I
AUTHORIZATION
TOTAL FEE I / / I C�'O y
REIMBURSEMENT FEE
1 HAVE AT THIS GATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED
APPROVALS
I Dq TE
INSPECTOR'
EXISTING DWELLING -
TO THE PUBLIC SEWE
PB,/�
NEW HOUSE SEWER
I
t�
„SS16N�TURE-
SIGNED THI DAY OF Y Ig�� _
Ill���lllddd'-��'
OWNER ORCONNECT
)WNERS AG T J�(J/7o- L
,
ADDITIONAL
BUILDING OR WORK
I ( I
7
4DDRE53 a�// j !f!.,�_
TANK. SEEP,
AND/ORSEPTIC
DRAINF ELDPIT(S)
ING STATE THAT ACKNOWLEDGE
ABOVEHAT EAD 15 CORRECT THISICATI ON
❑ CESSPOOL
AGREEA TOL COMY
VITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PL - 3
ILUMBING
DRYWELL❑
AND SEWERS.
ALTER, REPAIR, SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REG STEREO AND/OR 3
SEWAGE DISPOSAL SYSTEM
_
.ICENSED AS REQUIRED BY LOS ANGEL S COU Y AND STATE OF
:ALIFORNIA OR THAT I
DISCONNECT PLUG AND
I I
'
AM THE LE 0 ER OF THE A yE -
iESCRIBEO RESIDENTI ROPERTY.
ABANDON HOUSE SEWER
A
IGNATURE
OF PER MITT '_
BACKFILL SEPTIC TANKS ❑
SEEP. PIT(S) ❑ CESSPOOLS L9
�pIiLYYIIIL dlld ul.xiu� LJlli Inlll�aal4 J,' Iei16.I1, til L. ei.. i�lli AA
H�I q. Y
N A. LAMBIE. C Y ENGINE
LIDATION
CK. M. O. CASH
Yp DO
ROBERT A. WOOD. CHIEF PLBG. INSPECTOP
rvAY23 4 A 4.50
TC
Cf)
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