HomeMy Public PortalAbout10802 GRAND AVE_Sewer__ IFlk APPLICATION FOR PERMIT
DIVISION OF-BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL - 1
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Co,� oa cf LAnQ.lK kBINGJOHN A. LAMBIE, CouNTY ENGINI21KR E"T) CAIMaTT D.GRIFFIN, Sur^To�BUIL61NO �.13� FOR APPMCANT TO FILLIN eTeT. G
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DES IPTTON LOT NO.
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B-LOCL TRACT ADDRESS
N0,OF BLI)GS. Com. TEL NO.
SIZE OF LOT NOW ON LOT
USE OF DISTRICT N0. GROUP IA!
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ADDRESS �L , PCO}�� �IOlt DATA
4 STIftIOM t/ V DEPT - y-
CLTY �L rY..f� TI L. N0. �e
IANHOL.E REFUENCH 44-I _
R9CISTRATION NO. J OUNTY ATE LOVER
NO. DESCRIPTION OF WORK FEE
OUSE SEWER C XNE IMG TO / TYPE OF CONNECTION LENGTH.FROM
PU LLC SEWER 3.30 7 Y' CURB P.L. Y.L TO P.L
SEPTIC TANK,SEEPAGE PIT OR
PITS AMD/OR DRAINFIELD Q 3.00
OVERFLOW aEEPAGE PI PRAINFIELD CO, IVP. X ./ JOB NO�
r TN.,CESSP00L DRYWELL MANHOLE 1.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SY Y ® S 4.00 TRUNK PERM T NO, ROAD PERMIT NO.
CONNECT/.DDI TONAL BLDG.OR 8T ENCROACHM�IT
WORK TO HOUSE SE17ER' ® 1.00 P Y T MO.
AL R.REPAIR OR ABANDON HOUSE IN
PUSTRIAL
SEWER OR DISPOSAL SYSTEM 1.00 WASYE APPROVAL
C HAIL G Eq
CONNECTION CkARGE FEl#
OWNtR.'S PMUCT i 1 00
,AUTHORIZATION TOTAL FEES � REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HtREIN NAMED CON• AMOVAIS DATE IMSPECTOR'SSI6 URE
TRACTOR TO CO"ECT THE ABOVE DESCRIBED EXISTING DWQxfwG '
TO THE PUBLLC $EW-ER. REV HOUSE SEWER
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SIGNED THIS F CONNECT ADDITIONAL
OWNER OR BUILDING OR VIORK
OWNERS AGEN_ SEPTIC TANK,SEEP,PITO)
ADDRESS - AND/OR DRALMFI LD
I HEREQY ACKNOWLEDGE TH,/4,T 1 HAVE REND THIS APPL CATION
AND STATE THAT THE ABOVE Y8 CORRECT AND AGREE TQ COMPLY CESSPOOL El DRYWELL Q
WITH ALL COUNTY ORDINANCES AXP STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGEDISPOSALB STEM
I HEREBY CERTIF7 THAT I AY PRtlPHRLY RECI3TERHD AND/OR DISCQMNECT PLUG AND
LI-CEMSED Aj REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOU�ESEWER
CALIFORNIA OR TI{AT AM THE LEGAL OWNER OF THE ABOVE
DENORIBED REBIDENY'A ROPERTY, BACKFILL SEPTIC T1�MKS❑
SIGNATURE
SEEP.PFECS) ❑ CABP.,LS❑
OF PERMITT
JOHN A. LAMB FE. OUNTY ENGINEHR VALIDATION ROBERT A.WOOD, CH16F PL.BG. INSPECTOR
3.7 7 9 n DEC 51 4 , 450
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