HomeMy Public PortalAbout8714 HERMOSA DR_Sewer__ CE3033-64 86420 APPLICATION FOR PERMIT
CE
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineev ADDRESS
WILLIAM A. JENSEN. Supt of Building
LOCALITY
NEAREST 117
FOR APPLICANT TO FILL UQ DRDSs 5T. /�Ot '
LEGAL
DESCRIPTION LOT NO. I/ U� OWNER 0
MAIL
BLOCK TRACT ADDRESS
SIZE OF LOT HOWOON LOTS / CITY TEL.
USE OF D15TRICT NO. GROUP MAP PROCESSED BY
SUIL.INGS
BK PG
CONTRACTOR �,�? �.
ADDRESS - � E+ G ���/// CONNECTION DATA
CITY TEL e;V4 � ST ION S, DEPTH F'I
STATE MANHOLE REFERENCE
REGISTRATION NO. pi(�/ �_ COUNTY LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNE LENGTH FROM
HOUSE SEWER CONNECTING TO Y. .L. M.L.TOP.L.
PUBLIC SEWER (ip $5.0°
P.C.NO. }
AGE
PETS AND/.R DRAPTIC TANK, INFIELDT OR @ SIO.00 CO.IMP. NO. f JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O
PRIVATE DISPOSAL SYSTEM 53.00 DDOIII
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVIIRz[K[x RECORD. INSTR,NO, DATE O
WORK TO HOUSE SEWER 33.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.,CESSPOOL,DRYWEL L.MAN H O LES S5.00 U
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING W
SEWER OR DISPOSAL SYSTEM ® $3.00STATE UO
PERMITENCROACHMENT
PERMIT NO. Z_
IN TRIAL
WA ST,APPROVAL
OWNERS PERMIT s 2 00 CHARGES
AUTHORIZATION TOTAL FEE ) CONNECTION CHARGE FEE
'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CO, REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE 17SPE24 SIGNATURE
SIGNED THIS DAY O% 19_
OWNER ORNEW EWER �/ F Vf
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP.PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Aryp/OR DRAINFIELD
FIELD
AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY DINANCE S AND STATE LAWS REGULATING
PLUMS
W MBING AND SEWERS. CESSPOOL ❑ ORYW ELL ❑
I HEREBY CERTIFY AT AM PROPERLY REGISTERED ANO/OR ALTER, REPAIR,SEWER OR
LICENSED AS RE°U E BY LOS ANGLES COUNTY AN. STATE OF S EWAGE DISPOSAL SYSTEM
CALIFORNIA OP T T AM THE LEGALER OF. A D INTEND TO DISCONNECT PLUG AND
PE510E IN, THE OV DESCRIBED RES NTIAL R PERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP.PIT ISI ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK. M.0. c�sH �l SUPERVISING MECHANICAL ENGINEER
� 1oS 3 2 DEC 27 1 0 A 7.00-
to
EER0fl 3-64
APPLICATION FOR PERMIT
88
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING p��i� ���
IOHN A. LAMBIE, County Engineer ADDRESS 6 T
WILLIAM A. JENSEN, Sup't of Building �• h 1
LOCALITY
NEAREST
FOR APPLICANT TO L IN `ROSS ST.
EGAL
DESCRIPTION LOT NO. ` OWNER
MAIL
BLOCK TRACT 3 ADDRESS ,(J�'[J SNOOF C ' / /
SIZE OF LOT NOW ON LOTS CITY 5 TEL. NO. 4/ ,W6 11-1,9d
USE OFDISTRICT NO. GROUP MAP PROCESSED BY
BUILDING$ BK /
TY%��' �� r r �G
CONTRACTO
ADDRESS ��- �/P , C CONNECTION DATA
�s ST ION DEPTH
CITY � S G. TEL. ` _ 2.
P/ r �J •� STATE MANHOLE REFERENCE Alr�
REGISTRATION NO. �U.iL.d R S' B COUNTY F) �. LOWER
NO, GESCRIPTI ON OF WORK FEE TYPEOFCONN T LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CU P.L. M.L.TO F.L.
FUEL IC SEWER Of SS.00
P.C.NO. Y
SEPTIC TANK.SEEPAGE PIT OR d
PITS ANO/OR DRAINFIELD 810.00 CO.IMP. NO. TOB NO. O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. Y///_ / U
PRIVATE DISPOSAL SYSTEM 33.00 TTT<➢C
CONNECT AD D ITIONAL BLDG. OR AFFIDAVIT I WAIVIRuSp[xi RECORD,INSTF.NO. DATE O
WORK TO HOUSE SEWER 53.00
OVERFLOW SEEPAGE PIT.DRAINF I ELO V
EXTN.,CESSPOOL,DRYWELL.MANHOLE SBOO W
NWT.OR ST.WIDENING
ALTER,REPAIR OR ABANDON HOUSE y
SEW R OR DISPOSAL SYSTEM S.O. STATE ENCROACHMENT VZ
p PERMIT NO.
INDUS TRIAL
NOVSTRIAL /n{
WASTE
APPROVAL
fJ ` �/-NJ
OWNERS PERMIT a CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON` REIMBURSEMENT FEE
ARTO O THE ABOVE DESCRIBED EXISTING DWELLING
TOTHEPUBLICSEWER APPROVALS
PATE INSPECTOR SIGNATURE
SIGNED THISO OF 19_
OWNER OR r� NEW..USE SEWER
OW AERSAGENT ///��V// CONNECT ADDITIONAL
BUILDING OR WORK 1
ADDRESS
SEPTIC TANK,SEEP.GRAINFIEL FIT(S)
1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION gryD/OR GRAINFIELD
AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITHALL COUNTY ORDINANCES
S AND STATE LAWS REGULATING
PLUM 8 ING AND SEWERS. CESSPOOL ❑ OflYW ELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED PND/OR ALTER.REPAIR,SEWER OR /
LIC ENSE0AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND f
RESIDE IN, THE A / DESCRIBEO, SIDENNkAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE DACKFLL.LSEPTIC TANKS ❑
OF PERMITTE ❑
SEEP.PIT IS) ❑ CESSPOOLS
VALIDATION ROBERT WOOD
CK. M.o. /( caSH }' SUPERVISING MECHANICAL ENGINEER
L.ACO 8 3 2 2 DEC 2 7 1 1 A 2 55.0 0