HomeMy Public PortalAbout5130 DOREEN AVE_Sewer__70AG426 APPLICATION FOR PERMIT90.E-063 1 L!!
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING` /
JOHN A. LAMBIE. COUNTY ENGINEER
ADDRESS O O Z
CASSATT D. GRIFFIN, SUPT or BUILDING LOCALITY f M pL r 7-4
FOR APPLICANT TO FULL"—CRO'S si.
DECRLEGIPTION LOT NO. SD. JO / %. OWNERMAIL
BLOCK TRACT //.290ADDRESS I/pNO. OF BLDGS.
CITY TTEL. NO.SIZE OF LOT NOW ON LOT 7Z"
USE 01 1DISTRICT N0. GROUP MAPBUILDINGSS/cf V` A
BK PG
CONTRACTOR v y'. U
ADDRESS/;1_0p0 JK 7, Lmcgy d!,
CfONNECTION DATA
CITY 'c4
I
QN - TEL. NO Z -6S -1-
STATION f-LDEPTH
MANHOLE REFERENCE
STATE LOWER
REGISTRATION NO. /6 f 3 8TY
A
pyN
N0. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWSEWER CONNECTING TO
@ O _CURB P.L. M.L.TO P.L.
PUBLSEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
CO. IMP. NO. lOB N0.EXTN.,CESSPOOL,DRYWELL,MANHOLE (41 $ 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 10. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Irl $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q S I.DD WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S pERMT S 00 '
AUTHORIZATION TOTAL FEE
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
k
APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESLkIBED EXISTING DWELLING I
TO THE PUBLIC SEWER.NEW HOUSE SEWER 11 e
SIGNED THIS-DAY OF C 7. 1g`+ CONNECT ADDITIONAL
OWNER OR BUILOING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL DRYWELL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROP LY REGISTERED ANO/OR } DISCONNECT PLUG AND
LICENSED AS R ED BY LOS,AN E5 UN AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA T 1 f E A WN THE ABOVE LI
DESCRIBED DE T I P O BACKFILL SEPTIC TANKS
SIGNATUflE
SEEP.PIT(s) CESSPOOLS
OF fpPERMIT
JOHN A. L T I VALIDATION ROBERT A. WOOD, CHIEF' PLeG. INSPECTOR
Clt. tl.0. CASH
LQ6145 GCT28 .10 A 5.00 M