HomeMy Public PortalAbout9843 ESTRELLA AVE_Sewer__ 76A 6420 -CESOS-1 0-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEW GE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION am LDINc
ADDRESS
LOCALITY -T�
NEAREST
FOR APPLICANT TO FILL IN DRG56 5
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DESCRIPTION LOT NO. OWNER Q� .SUY(✓
MAIL
BLOCK TRACT ADDRESS ^��7E
NO. OF OL GB.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
VSE OF
BUILDINGS DISTRICT NO. OR.UP BK MA
p F+ pROC SED BY
CONTRACTOfl �/Ef�[L �B6«/AI" /n�G '5-'D �� 4 7 I
ADDRESS , doA- ./G FY CONNECTION DATA
CITY 09711";441"A"14 TEL. NO. T i 'I STATION DEPTH
STATE LIC
LICENSE NO. Jr�S_fS CLASS l- 7 y MANHOLE REFERENCE , LOWER
No. _DESCRIPTION OF WORK FEE TYPE OFC TION LENGTH ROM
HOUSE SEWER CONNECTING To Y. CURB P.L. M,L.70,L /—
PUBLIC SEWER $7.00
SEPTIC MNK.SEEPAGE PIT OR f� P.C.NO.
PITS AND/OR DRAINFIELO SIO.00 CO.IMP. NO. 30B NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, y
PRIVATE DISPOSAL SYSTEM 53.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT En 'EEEEKEHT RECORD.INSTR.NO. DATE V
WORK TO HOUSE SEWER 53.00
OVERFLOW SEEPAGE PIT.GRAINFIELD w
E ATN_C ESSPOOL.ORYWELL. ® S5.00 O
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING 1-
SEWER
SEWER OR DISPOSAL SYSTEM ® $3.00 STATE ENCROACHMENT V
W
MANHOLE ® $7.00 PERMIT NO.
INDUSTRIAL 0 N
WASTE APPROVAL Z
CHARGES
OWNERS PERMIT s 3 00
AUTHORIZATION TOTAL FEE C �� CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED Co. REIMBURSEMENT FEE
TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER..4—
APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS_F�DAY�L 4/ 'SZ.
('// NEW HOUSE SEWER
OWNER OR
OWNERSAGENT .•�n�Eu?U_ fc.'/A2�� CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP.PIT(S)
HEREBY ACKNOWLEDGE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT TXE ABOVEEIS 15 CORRECREC T ANO AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL ❑
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANG/OR ALTER. REPAIR.SEWER OR
LICENSED AS REOWRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT)- M THE LEGAL OWNER P. AND INTEND TO
RESIDE IN, THE OV DESCRIBED RESIDENTIAL PROPERTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIGNATV RE BACKFILL '' �f
OF PERM �" ' �`=�^• CK CESSPOOLS :t
'VALIDATION l CR' M.O. CASH
I JP, 2 1 9 1073 JUL 13 1 '0 D 1 0.00A
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