HomeMy Public PortalAbout8712 HERMOSA DR_Sewer__ DEB0B 3-54
76A6420 3 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 7�.Z rA70 Q
JOHN A. LAMBIE. County Engineer ADD PESs
WILLIAM A. JENSEN. Supt of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO O / OWNER
MAIL
BLOCK TRACT 3 6 z � ADDRESS c�3d p / �j
NO. OF BLOTS. / CITY ✓ TEL. NO. (p ��d D
SIZE OF LOT NOW ON EOi
USE OF FD . GROUP MAP PROCESSED BY
BUILDINGS
BK PG
CONTRACTO '-;tCTION DATA
TEL. O - DEPTH
STATEFERENCE
REGISTRATION NO. COUNTY L!' LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF NNE I LENGTH FROM
HOUSE SEWER CONNECTING TO Y. _ R P.L. M.L.TO P.L.
PUBLIC SEWER 49 35.00 P.C.NO 1•
SEPTIC TANK.SEEPAGE PIT OR CO.IMP. NO. JOB NO. O
PITS ANO/OR DRAINFIELD ® 310.00 /�
HOUSE SEWER CONNECTING TO THUNK PERMIT NO. ROAD PERMIT NO. Y/ a v
PRIVATE DISPOSAL SYSTEM N 53.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT uv rtR[Rt RECORD.INSTR.NO. DATE a'
WORK TO HOUSE SEWER 0 $3.00 0
OVERFLOW SEEPAGE PIT,DRAINFIELD G
EXTN..CESSPDOL.DRYWELLMANHOLE@ SS.00 W
A LTER,REPAIR OR ABANDON HOUSE HW Y.OR ST.WIDENING a
SEWER OR DISPOSAL SYSTEM ® 53.00 STATE ENCROACHMENT N
PERMIT NO.
INDUSTRIAL /
WASTE APPROVAL
CHARGES
OWNERS PERMIT
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON • REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOfl'8SIGNATURE
SIGNED ORIS DAY JOF_� 19_
OW NEDfA_YL.t NEW HOUSE SEWER
OWNERS AGENT r`� CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BEPTICTANK.SEEP.PIT PIT(S) I/ A/E'\
AND/Ofl DRAINFIELD �•
AN.WITH
STATE THAT TXE ABOVE IS CORRECT AND AGREE E COMPLY
WITH ALL COUNTY OflDINANCE9 AND STATE LAWS REGULATING CESSPOOL ❑ DRYW ELL ❑ J
PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANp/OR ALTER.REPAIR,SEWER OR i
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT AM THE LEGAL OWNER OF, NO INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A E EBCRIBEDD R ENTIA P OPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTE BACKFILL SEPTIC TANKS ❑
SEEPKFIL SE ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
K. M.O. /l c J SUPERVISING MECHANICAL ENGINEER
LAj08320—� DEC27I I A 255.00^' e
DE3033-Ea
76AE42D APPLICATION FOR PERMIT �I
u
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING p
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAREST
FOR APPLICA T TO FILL `ROBS ST. L
LEGAL //1�.
DESCRIPTION LOT NO. / O OWNER _/�L,y
MAIL q
BLOCK TRACT 362 3 ADDRESS
NO. OF BUDGE. TEL. NO.`l UIO /"! �L^/
SIZE OF LOT NOW ON LOTTCITY ITY
USE OF
BUILDINDISTRICT NO. GROUP BK MAP PO PROCESSED BY
GS �5 p
'ArCONTflACTO - /� �C r— �• (J,J j
ADDRESS 3 �S /�/ .✓ CONNECTION DATA
CITY TEL. % G ST ION OEPTN
❑ STATE MANHOLE REFERENCE y
REGISTRATION NO, ❑ COUNTY (( LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CO N LENGTH FROM
HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L,
PUBLIC SEWER @ $5.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO, r
PITS ANO/OR GRAINFIELD ® !10.00 CO.IMP. NO. JOB NO. d
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
.0 /SC O
PRIVATE DISPOSAL SYSTEM ® 330
CONNECT ADDITIO N AL BLDG.OR AFFIDAVIT I WAIVIN I IIAS[IIINT RECORD. NSTR.NO. DATE w
WORK TO HOUSE SEWER $3.00 O
OVERFLOW SEEPAGE PIT.DRAINFIELD v
EXTN_CESSPOOL.DRYWELL.MANHOLE If 55.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING W
SEWER OR DISPOSAL SYSTEM It S.Oo
STATE ENCROACHMENT Q.
PERMIT NO. _Z
INDUSTRIAL �f /
WASTE APPROVAL
OWNERSI PERMIT sl z 00 CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAME; CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPE&QRB'SIGNATURE
SIGNED THIS DAY/019_ 1"
OWNER ORPYv/Q NEW HOUSE SEWER
OWNERS AGENT C� - I
CONNECT ADDITIONAL
ADDRESS BUILDING ORRWORK
WORK
SEPTIC TANK.SEEP.PITIS)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION pryD/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY RE015TERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REOUIREBY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT IDA M THE LEGAL OWNER OF. A O INTEND TO pIBCONNECT PLVG AND
RESIDE IN, THE DESCRIBED RE$YpENTIA' PR ERTY. ABANDON HOUSE SEWER
SIGNATURE JU� BACKFILL SEPTIC TANKS ❑
OF PERMITTEE EP,PITI51 ❑ CEBBPCOILS ❑
VALIDATIO�I�� ROBERT WOOD
(\ SUPERVISING MECHANICAL ENGINEER
CK. M.0. CASM
8 3 1 9G DEC 27 1 0 A 7.00- Q
C
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