HomeMy Public PortalAbout5709 OAK AVE_Sewer_7/10/1957_S42&E-6°
S 11-55 APPLICATION
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DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles
JOHN A. LAMBIE, COUNTY ENGINEER
kJ CASSATT D. GRIFFIN, SUPT OF BUILDING
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FORA,} .LICAN; T FILL IN
LEGAL / I f / z C
DESCRIPTION N LOT N0. 7
BLOCK TRACT?
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT
USE OF ��y�/�/�/
BUILDINGS /r. 1Z12.Q�f/ X alA
FOR PERMIT
SEWER—SEWAGE DISPOSAL
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ADDRESSBUILDING n-7 �.�'r 1!/f/ /L/!
LOCALITY
NEAREST
CROSS BY J 7/r
>y":
OWNER ()'��s �/f�./�y <-ydi�iA�i�
MAIL
ADDRESS A / CY �7 r 4.1 � 4�G}1�i
CITY v TEL. N0 7— al Lil
DISTRICT NO. GROUP MAP
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CONTRACTOR A/ CAt P! M G It
-5
BK PG
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ADDRESS �ZS` L. RFv n+-4
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DATA /
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CITY A& 4
t�b 5"
�C-O/NNECTION
STATION �/_ % DEPTH (Q
_
J -I `
_ MANHOLE REFERENCE /span` rye � - 5I� LOWER
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REGISTRATION N0. / J � r � �
.LACTATE
❑ COUNTY
�7
No.
DESCRIPTION OF WORK FEE
-
t
HOUSE SEWER CONNECTING TO�./
_ TYPE O�,QBTit�ECT10N LENGTH FROM
Y. lk`! gg P.L. M.L. TO P.L. 7 All
`1(
PUBLIC SEWER @ $ 3,50
7 VI
T
SEPTIC TANK, SEEPAGE PIT OR
PITS Al GRAINFIELD @ S 3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
- P. C. NO.
EKTN..CESSPOOL,DRYWELL, MANHOLE @ $ 2.00
CO. IMP. NO. �.J 2j JOB NO.HOUSE
ER TO
TRUNK NO. - 96 All /y
�'{
PRIVATE DISPOSAL SYSTEMG @ $ 1.00
CONNECT ADDITIONAL BLDG. OR
PERMIT ROAD PERMIT N0.
4 STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $ 1.00
' PERMIT NO.
ALTER. REPAIR OR ABANDON HOUSE
INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $ 1.00
WASTE APPROVAL
CHARGES
9 CONNECTION CHARGE FEE
OWNER'S
PERMIT $
1
00
=_
AUTHORIZATION
TOTAL FEELj
REIMBURSEMENT FEE
APPROVALS ATE INSPECTORS SIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THI D� _ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
All
OWNERS AGENT SEPTIC TANK, SEEP, PIT(S'.
ADDRE« = Al DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ? CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
LU
PMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
DESCRIBED RESIDENTIAL P ERTY. = BACKFILL SEPTIC TAN
SIGNATURE / = SEEP. PIT(S) ❑ CESS
OF PERMITTE .�A- /T'
111, CN�l(1mif"Am noueY.114, .iY�u""'l ua,., III 1Y.,n111111,1 n1.�� 1 1
JOHN A. LAMBIE. CNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
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