HomeMy Public PortalAbout10818 GRAND AVE_Sewer__ APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
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JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
m CASHATT D. GRIFFIN, DOp'T OF BUILDING LpCAL•RiqRAREST FOR APPLICANT TO FILL IN Caoss rT.
LEGAL OW11HA
DE!C.RIPTIO LOT N0.
BLOCK TRAOT . 7 ]SAIL
ADDXEBd
NO.OF BLDGS, CITY TEL. NO
r
SIZE OF LOT NOW ON LOT
USX OF DISTRICT N0. GROUP YAP
BUILDINGS
Q
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CONTRACTOR 1 G //�
ADDR>ESS CONN=ON DATA
STATION DKM
CITY TEL No. IAA H 0 LE REFEM CY / 77, '7,S
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�'3TATE / 7 LOW HR
REGISTRATION NO. ❑ COUNTY
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM /
HOUSE SEWER CONNECTING 7Q Y. CURB P.L. X.L.TO P.L.
PUBLIC SEWER 3.50 O -
SEPTIC TANK,SEEFAOE PIT OR
,ITS AXD/OR DRAINFIELD @ S 3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
EXTN.,CESSPOOL D.4 L MANHOLE 2.00 CO. IVP. X0. JOB NO. -
HOUSE SEWER CONXECTING TO
PRIVATE DISPOSAL SYSTEM @ f 1.00 TRUNI PERMIT NO. ROAD PERMIT NO. ,6 Q
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER 3 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL.
SEWOR DISPOSAL SYSTEM 11.00 WASTE APPROVAL
C H"G ES
CONNECTION CHARGQFEE _
OVPNEE'S PEHIr s 1 00
AUTHORIZATION TOTAL FEE REIYBUFL7EMEXT FEET�
• APPROVALS PATE IXSPHCTOR'SSIGNATURE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAYED CON-
TRACTOR TO CONNECT THE AS DESCRIBED EX13TING DWRnING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS F CONNECT ADDITIONAL
OWNER ORBUILDING OR WORK
OWNERS AGENT SEPTIC TANK,BEEP,PIT(S)
A DR AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE'THAT I HAVE READ THIS APP CATION CESSPOOL ElDRY-WELL ElAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSES EQ
CALIFORNIA OR THAT I A THE LEGAL XER OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP.PIT(S) ElCEss POOLS❑
-
OF PHRYITT
JOHN A. LAMBIE. Co TY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PL,DG. INSPECTOR
3 7 8n N DEC 31 _ 4 4.5 0 tD