HomeMy Public PortalAbout10823 GRAND AVE_Sewer__ r ,
APPLICATION FOR PERMIT 1
DIVISION OF B=ING AND SAFETY S EW E R--S EWAG E DISPOSAL
D"-rfta� of C--iy E Wb~
Co=iT of Los &wma" FnWEAkM
DING
'JOHN A. LAMBIE, COUNTY ENGINIZEN S
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m tJMSATT D.GRIFFIN, 8Ur'T OrDU11y1N0 LTT7
FOR APPLICANT TO FILL IN .
LEGAL OWNER
-DESCRIPTION LOT NO,
BLOCK TRACT 'RAIL
ADDRESS
NO. OF BLDGS. CIIYV14 TEL N0.
8I OF LOT NOW OX LOT L.
USE
BUILDINGS DDISTARC-f NO. - GROUP YAP
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+(r` [ GBK P�
CONTRACTOR1
COMEC-40N DMA
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STATIOA 0� / DEPTH
CITY /{1 n�- 7II..XO. O MANHOLE REffig"Cli
J;J SWATH 7 r
REGISTRATION NO. ❑ 000NTY -
140. DESCRIPTION OF WORK FEE
HOUSE SEWER Coxl1ECT1 G TO T7FH OF CORRECTION LEAGTFROM
-PUBLIC SEWER @ 3,50 a
Y. CURB ,L. YM.L.TOO P.
SEPTIC TAIIK,SEEPAGE PIT OR
ITS AND/OR DRA XFIELD ® 5.00
OVERFLOW SEEPAGE PIT, DRAIIIF ELD R. C. 110.
EXTN.,C S OOL DRYWELL,YANHOLE @ 2.00 CO. IMP, NO. JOB NO.
HOUSE SEWER CONNECTING TO _
PRIVATE DISP09 SYSTEM S 1.00 TRUNK PERMIT A0. ROAD PERMIT N
CONNECT ADDITIONAL BLDG.OR STATE ENCRQA
WORK TO HOUSE SEWER ® f t.00 PERRIT X0.
ALTER,REPAIR OR ABANDON HOUSE INDppSTRIAL
SEWEROR DISPOSAL SYSTEM 1.00 WASTE APPROVAL
CHARGES
COXNEC710 $ARDS FEE
OWNER'S P.EH.MIT s - I o0
AUTHORIZATION TMAL FEE y 513 REIMBURSEMENT FEB
I HAVE AT TH1S DATE A GOXTRACT WITH. THE HEREIN RAYED COLI- APPROVALS DA-rE INSPECTQR"SSIG[ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING /
TO THE PUBLIC SEWER, NEW+LOUSE SEWER
SIGNED THI AY 1OF CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT IS)
ADb ES AND/OR DRAINFIE D
1 HEREBY kCKJQWLEDGE THAT I HAVE READ TN14 APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITH AI,L COUNTY ORDINANCES AND STATE LAWS REGIILATIXG ALTER,REPAM SEW£R Ott
LDESCRIBED
AND SEWERS. BE-WAGE DI PO L STEM
HE
CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG ANp
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF .AB DOX HO
SEWER
A. OR THAT I '61'
THE LEGAL OWNER OF THE ABOVE
RESIDENTIAL OPERTY. BACKFILLSEPTICTANKSa
ffEEP. PIT(S) ❑ CESSP00
JOHN A. LAMBIE, NTY ENGINHER -�/AIMATION ROBERT A. WOOD, OHI[r G. I148pECTOIk
4 7 0 En FEB 6 4 4.5 0 tn