HomeMy Public PortalAbout8631 HERMOSA DR_Sewer__ 9APPLICATION FOR PERMIT 1
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Ga _eBDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING ` II
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ♦^ i �. -yC
® CASSATT D. GRIFFIN. SUPT of BUILDING LOCALITY / ,
(ti
'FOR APPLICANT /TO FILL
{IN . �
NEARESTS .
DESCRLEGIPTION LOT NO.�I 0a S` J ��j OWNER ( ♦ \/ • �Y(��
/^) MAIL
BLOCK TRACT % V ADDRESS
JJJ NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
USEUSE DDISTRICT NO. GROUP MAP
W LL BK PG
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CONTRACTOR el. L.$ � /� k/,/Z
ADDRESS _ - '/ 9wwCODATA
F
Y/NNECTION / T
CITY 7 I TEL. NO. A'Tc / 2/,1♦ STATION SL�L' /♦ DEPTH (jZ
MANHOLE REFERENCE
`_�7 AT
ST j f A G `� ^• ,LOW SII/
REGISTRATION NO. � / �+❑ COUNTY
NO.. DESCRIPTION OF WORK FEE r TYPE OFC�g CTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y'_ /QURHJ P.L. M.L. TO P.L.
_ PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PIT$AND/OR DRAINFIELD Q E 3.00 / J/,
OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO. /,�/EJ JOB NN
O.
EXTN.,CESSPOOL,DRYWELL.MAN HOLE �V $ 2.00 � 0.
HOUSE
SEWER CONNECTING TO
PRIVATE WEE SYSTEM Ca E 1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER (R $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
_ CONNECTION CHARGE FEE
OWNER'S PERMIT 5 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED co N. APPROVALS DATE INSPECTORS SIGNATURE
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -� ^_♦
TO THE PUBLIC SEWER. �A NEW HOUSE SEWER Lr/
SIGNED THIS Y OF zL a 19 ` CONNECT ADDITIONAL
OWNER OR // BUILDING OR WORK
OWNERS AGENT_ n `N❑ G
ADDRESS CJ -L1nvvin.l.a AND/OSEPTIC TANK,SEEP,PIT(5)
DRAINFIELD
R
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY R GISTERED AND/OR DISCONNECT PLUG AND
LICENSED A5 REOUIRED BY LOSS
Y AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT i AM THE LEGAL WNER OF THE ,ABOVE .!
DESCRIBED RESIDENTI PROPERTY` % '06/ BBAACKFILL aCA4Tftr ES9 J,S�
SIGNATURE
OF PERMITTE •ice
JOHN A. LAMBIE. C TY ENGINEER ALIDATIOt, ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. M. 0. CASH
9a1� �5I.:L ; } 4.5 In