HomeMy Public PortalAbout9849 ESTRELLA AVE_Sewer__ 7BA64 0 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F
UILDING
JOHN A, LAMBIE. Covvty Enggineer DDRESS
WILLIAM A. JENSEN, Suptf Huil, CALITY
NEAREST
FOR APPLICANT TO FILL. IN cao3S ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT O MAIL
ADDRESS
N0.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS DISTRICT NO. GROUP YAP V BK P6
PROCESSED BY
—
CONTRALTO ti'T yU` CJv
ADDRESS Jt� CONNECTION DATA
ClTEL.NO. STATION `5� DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO. / COUNTY I I-' LOWER 1
No. DESCRI TION OF WUNK FEE
/ HOUSE SEWER CONNECTING TO
PUBLIC SgEWER @ $3.00 TYPE OF CT LENGTH FROM +.
SETPTIC T ING/ NK,OR S EPAGE PDT OR @ 59.00 Y. CURB P.L. Y.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD T
EKTN..CESSPOOL.DRYWELL @ $2.00 OL
HOUSE SEWER CONNECTING TO -'.P.C.NO. Q
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.INP.N0. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0. y
WOR K TO HOUSE SEWER @ $1.00
ALTERO
,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT G
SEWER,
EW ER OR DISPOSAL SYSTEM
@ $1.00 PERMIT NO.
INDUSTRIAL W
WASTE APPROVAL w
N
CHARGES Z
OWNERS PERIt'BT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. T f
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DAj# INSPECTORB,SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THI DAY OF. IH_ NEW HOUSE SEWER I
9M!lf�QR CONNECT ADDITIONAL
OWNERS AGE BUILDING OR WORK
SEPTIC TANK,SEEP.PIT($)
ADORES AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESID� AL PR PERTY.
SIGNATURE SEEP. PITIS ❑ CESSPOOLS
OF PERM ITTE
VALIDATIOTY� ROBERT WOOD
(:A. Y.o. /6PcwN SUPERVISING OB MECHANICAL ENGINEER
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