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Home My Public Portal About8715 HERMOSA DR_Sewer__ CEBOe 8 58 7 APPLICATION FOR PERMITfZ/j-r &8 � 7 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING ADDRESS OHN A. LGRIFFI . Sup -I miler g � C SATT D. GRIFFIN, Supt of Buildviq LOCALITY NEAREST FOR APPLICApNT TO FILL IN CROSS STLEGAL .. DESCRIPTION LOT N0. p 0 OWNER BLOCK TRACT MAIL 17 ADDRESS 40-4214 NO.OF RLDGS. SIZE OF LOT 0 0 NOW ON LOT CITY TEL. NO. USE OF DISTRICT N0. GROUP MAP PRO ESSEO BY BUILDINGS it BK Pg, CONTRACTOR `J ADDRESS I / CONNECTION DATA CITY EL.N0. STATION �'rj�.� '7 0 DEPTH TATE MANHOLE REFERENCE UPPER REGISTRATION NO. COUNTY ZOW.ER NO DESCRIP FEE ,? HOUSE SEWER CONNECTING TO s✓' PUBLIC SEWER @ $3.00 SEPTIC TANK,SEEPAGE PIT OR PE OFC CTION LENGTH FROM PITS AND/OR GRAINFIELD @ $5.00 Y. 'URB P.L. M.L.TO P.L. V OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C. O. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. /- CON JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. �♦ WORK TO HOUSE SEWER @ $1.00 AEWER OD DAS POSAL SYSTEM HOUSE @ $100 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE L p/ U C 5 1,p 00 AUTHORIZATION TOTAL FEE ry REIMBURSEMENT FEE / 17 S`' I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC j W SIGNED THIS /+ DAY OF 1 9foLo NEW HOUSE SEWER OWNER OR /' CONNECT ADDITIONAL OWNERSDDRESS AGENT BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) A AND/OR GRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [IDRYWELL ❑ WITH ALL COUNTY ORDINANCE$ AND STATE LAWS REGULATING AL TER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS flEOBY LOSS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA THAT HAT i AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPER BACKFILL a� SIGNATURE i -SEEPd CESSPOOLS 9^/ //. /iii Luer✓ OF PERMITTE ®" VALIDATI ROBERT GMECHANICAL E - CK. Y.°. SB SUPERVISING MECHANICAL ENGINEER 24650 INSERTS CE6066.60 7 BA6620 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER ADDBULL 'No _�jj jC.SA BUILDING AND SAFETY DIVISION D RESS - /7 /S r TORN A. LAMBIE, CO.. E. i.-er /y / WILLIAM A. JENSEN. Sup'! of Building LOCALM NEAREST FOR APPLICANT TO FILL IN CROSS ST. � /_ y ,"7ZLrLEGAL [/ DESCRIPTION LOT NOYr � V,�ly fJ OWNER VAl `/'. �f BLOCK TRA yCTJ -4 (qa ADDRESS 8 / C_ 6e�WL S NO.OF //�'�� SIZE OF LOT ��q .0 OV NOW ON LOTS CITY !I C EL. N0. / b J USE DI DISTRICT NO. GROUP BK MAP PG PROCESSED BY BUILDINGS vYE.0 .NG fC' 'f1,PAdE r CONTRACTOR G 1'✓/1/Lt� �Q'1 1 /L V/_ ADDRESS E' -_// CONNECTION DATA —� CITY TEL.NO. STATION DEPTH STATE MANHOLE REFERENC UPPER REGISTRATION NO. COUNTY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE'DF LbNNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD CESSPOOL DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. J00 N0. r CONNECT ADDITIONAL BLDG.OR ..� TRUNK PERMIT NO. RO RMIT N0p WORK TO HOUSE SEWER @ S1.00 . U ALTER. REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $I.Do PERMIT NO, p INDUSTRIALU WASTE APPROVAL W CHARGES Val OWNER'S PERMIT 52 00 CONNECTIO CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTOR TO CIONNECT THE AB VEDATE AT DESCRIBEDEXIISTIWITH THEINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSESEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PITS) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR PLUMBING AND SEWERS. ALTER.REPAIR. DISPOSSEWER OR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR SEWAGEM DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT PROP TY. ^ BACKFILL SEPTIC TANKS ❑ SIGNATURE C (� SEEP. PIT(S) ❑ CESSPOOLS ❑ OF PER MITTE Or VALIDATION ROBERT A. WOOD CK. M.0. (u ' SUPERVISING MECHANICAL ENGINEER [eco 0 1 2 3 * JUL 1 8 1 0 A 3 .0 0