HomeMy Public PortalAbout9827 ESTRELLA AVE_Sewer__ TapaaaaAPPLICATION FOR PERMIT .
ceeoe-e-ae COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -..:>.. .. ... ... .. ... . - -_... - �,
BUILDING AND SAFETY DMSION
ADDRESS
'
TORN A. LANIBIE, CauafT Pmgiaeet �
CASSATT D. GRIFFIN, Sup'i of Baildia4 LOCALITY v . 1 'G
FO - NEAREST
PPLIR ACANT TO FILL IN CROSS ST./
LEGAL OWNER
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DESCRIPTION LOT N0.
BLOCK TRACT , MAIL
ADDRESS
N OF BLD S. - ,
SIZE OF LOT NOW ON LOT CITY TEL. N0.
h USE OF _ TRI - -'
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG 1
o CONTRACTOR ' -I
ADDRESS DATA
T`�L`-+(
CITT TEL. NO / STATION DEPTH
[ $TATE ,. MANHOLE REFERENCE J UPPER
REGISTRATION N0. / --� ❑ COUNTY r
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO .* -
PUBLIC SEWER @ $5.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF ION LENGTH PFROM /
PITS AND/OR DRAINFIELD @ $5.00 Y. UR8 P.L. M.L.TO .L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO,IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR - TRUNK PERM TND. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
SEWER OR DISPOSAL SYSTEM HOUSE @ $1O0 PSTATE ERMITENCROACHMENT
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 4�71e
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I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - I
SIGNED THIS DAY OF I g�" NEW HOUSE SEWER Z -'F O ( i
OWNER OR CONNECT ADDITIONAL'
OWNERS AGENT BUILDING OR WORK
[ALTER,
TIC TANK, SEEP, PIT(S)
ADDRESS /OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYSPOOL❑ DRYWELI❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING REPAIR,SEWER OR
PLUMBING AND SEWERS. AGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REG15TERED AND/ORCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFNDON HOUSE SEWER
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI Y"IPROPERT/Y, KFILL SEPTIC TAN K5❑SIGNATURE / �/ - P. PIT(5) ❑ CESSPOOLS
OF PERMITTE ) 1
®t ALIDATION ROBERT A.WOOD
gp, M.p, G d SUPERVISING MECHANICAL ENGINEER
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