HomeMy Public PortalAbout5139 DOREEN AVE_Sewer__TEMPLE C0TY
EA042°Cee08 °.ea APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION em LDING .,ADDgESS /7 J
IOPAt A. LAMIE.
GRIFFI , S.p t Ef B.
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YCASSATTD. GRIFFIN. Supt of Building LOCALITY
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FOR APPLICANT TO FILL IN cgoss s
LEGALDESCRIPTION LOT N0. a
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OWNER
l BLOCK r TRACT 0 MA ILADDRESS fJ/a•O•I G/JL 1
SIZE OF LOT GNOW ON
LOTS
CITY /G%'1 C JY TEL. NO.
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BUILDINGS N//1 DICT N0. G.RO U+P
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PROCE DrBY
CONTRACTO e?, I
ADDRESS 3n CONNECTION DATA
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CITY
i/.fP/7 TEL.NO,. 9 ATION 0 4 S DEPTH
O i TATE MANHOLE REFERENCE
REGISTRATION NO. o COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ YPE C ON LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR P.L. M.L.TO P.L.PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTH..CESSPOOL. DRYWELL @ 52.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ S1.00 TRUNK PERMIT NO. ROAD PERMIT ND.
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT ND.
1 INDUSTRIALikWASTEAPPROVAJ$gald P T4
CHARGES
OWNER'S PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 7 100 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGN T E
TO THE PUBLIC SEWE
SIGNED THIS DAY OF /N !le 19 NEW HOUSE SEWER I
OWNER OR 1 y CONNECT ADDITIONAL
e. OWNERS AGENT 1 BUILDING OR WORK
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 L, CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER ORPLUMBINGANDSEWERS.
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG ANDLICENSEDASREOUIREDBYLOSANGELESCOUNTYANDSTATEOF , pgAN DON HOUSE BEWERCALIFORNIAORTHATMTHELEGALOWNEROFTHEABOVE
DESCRIBED RESIDENTI OPE RTY BACKFILLSEPTIC TANKS
SIGNATURE
SEEP.PIT(S) CESSPOOLS
OF PERMITTE
T,L ROBERT A. WOOD
CK. Y..O.0. CASH SUPERVISING MECHANICAL ENGINEER
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