HomeMy Public PortalAbout8600 HERMOSA DR_Sewer__ D
CE608. APPLICATION FOR PERMIT _ 1
eeoe-epee COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. LAN'DiTE, County Emginaer ADDRESS n`
CASSATT D. GRIFFIN, Sup't of Building LOCALITY S.9-/71EkREIT
FOR APPLICANT TO FILL IN
CROSS ST. 7-5U
LEGAL a / fYle 1i SZF,�,
DESCRIPTION LOT NO. (S� OWNER /J
moor' TRACT A .. / "z Y"T ON / ADDRESS
NO.OF SLOGS.
SIZE OF LOTS NOW ON LOT CITY TEL. N0.
USE OF
BUILDINGS DISTRI�O. GROUP MAP PROCESSED B
CONTRACTOR BK� � I PG
' U /
ADDRESS CONNECTION DATA
CITY L. STATION / DEPTH
STATE
REGISTRATION N . OUNTYMANHOLE REFERENCE/O,,3,, PE
�1-�// C 5-
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 O�
SEPTIC TANK, SEEPAGE PIT OR TYPE OFTION' LENGTH FROM 9' / /
PITS AND/OR DRAINFIELD @ $3.00 Y. CUR P.L. M.L.TO P.L. uC.
OVERFLOW SEEPAGE PIT, DRAINFIELD `' p
EXTN.,CESSPOOL,DRYWEL L,MANHOLE ® $2.00 - /' F/Q n/ N �//A'7 Al YF
HOUSE SEWER CONNECTING TO - P. C. NO.
PRIVATE DISPOSAL SYSTEM ® $1.00 CO.IMP.N0. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0.9S/
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT -
SEWER OR DISPOSAL SYSTEM a $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVMM'S PERMIT $ Z 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE Q REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THEPUBLIC SE R r�
SIGNED THIS AY OF Jg NEW HOUSE SEWER
OWNER ORp CONNECT ADDITIONAL
OWNERSAGENT t'l ��Q�/ BUILDING OR WORK
ADDRESS 8 B-t? gg SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIC TION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0-DRYWELL 0
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 1 THE LEGA NER OF .7N ABOVE
DESCRIBED RESIDENT 'P PER / BAC KFI LL 9l1'J qq..ss ��yL,,_�
SIGNATURE / SEEP. PITS) CESSPOOLS /-O=GO 9/, 9" ltr�
OF PERMIT TE
®� VALE)ATION,,6) ROBERT A.WOOD
gX. M.0. SUPERVISING MECHANICAL ENGINEER
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