HomeMy Public PortalAbout9846 ESTRELLA AVE_Sewer__ 'BA 6420;i`E'°ID '0 " APPLICATION FOR PERMIT I/P
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION BUILDING �I .+' �, A
ADDRESS v
LOCALITY Z Fm u /,,1�5' Cl TX
NEAREST
FOR APPLICANT TO FILL IN =ROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER /' J
MAIL (+
BLOCK TRACT ADDRESS �1
NO
SIZE OF LOT
O O NOWOONBLOTS CIT G T NO.
USE OF DISTRICT NO. GROUPMAP PROCESSED BY
B V ILDINGS
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CONTRACTOR5 V 8 .L L - 8,7
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ADDRESS p�, /j S—� CONNECTION DATA =!t
CIT Q TEL. NO. STATION f�p` DEPTH
STATE A LIC MANHOLE REFERENCE UPPER
LICENSE NO v GLASS —w4; 76 OWER
NO. .DESC PTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO .J� Y. URB P.L. M.L.TO P.L.
PUBLIC SEWER ® $7.00 C• V
SEPTIC LANK.SEEPAGE PIT OR P.C.NO.
PITS AND/OR GRAINFIELD ® $'OOo CO.IMP,NO, JOB NO.
HOUSE SEWER C ONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM ® 83.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDwVIT uv u5[x[x♦ RECORD.INSTR.NO. DATE v
WORK TO HOUSE SEWER 53.00
OVERFLOW SEEPAGE PIT,GRAINFIELD
EXTN..CESSPOOL,DRYWELL. ® SS.00
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING O 0
SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT V
W
MANHOLE ® $7.00 PERMIT NO, y
INDUSTRIAL h
WASTE APPROVAL Z
OWNERSI PERMIT $ CHARGES
a oo-
AUTHORIZATION I TOTAL FEERte\ONCONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED!/CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER y'
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK,SEEP,PIT ISI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORVWELL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE OISPO SAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWN OF. ANO IN ENO TO DISCONNECT PLUG AND
RESIDE IN, THE AB ESCRIBED RE D IAL PROPE ABANDON HOUSE SEWER
SIGNATURE
OF PERM RTEE BACKF SEPTIC TANKS ❑ _T�,_Z
SEEP. IT151 ❑ CESSPOOL
VALID,LTIOW. CK' M:O. CASH
Li" 9080N OCT 4 1 0 D 1 0.00