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Home My Public Portal About8723 HERMOSA DR_Sewer__ C9808 10'62 76A842D APPLICATION FOR PERMIT I COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL lifl DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING IOHN A. BuildingLAMHIE, County Engineer Aooasss WILLIAM A. IENHEN. Svp'l of Building LOCALITY NEAREST FOR APL AN O LJ.N GROSS ST. LEGAL DESCRIPTION Y OWNER MAIL BLOCK TRACT 9 3 ADDRESS NO. OF SLEDS. SIZE OF LOT NOW ON LOT CITY TEL, NO. EE USE OF B V ILDINGS DISTRICT NO. GROUP MAP P OCE55 BY BK P�Gj J CONTRACTOR / i U ADDRESS �UU��Y// CONNECTION DATA CITY TEL. .� ION / C` DEPTH / M REGISTRATION NO. ANHOLEREFEGENCE J ER COUNTY NO. DESCRIPTION OR EE TYPE C TION ENGTH FROM HOUSE SEWER CONNECTING TO P.L. M.L.TO P.L. O PUBLIC SEWER ® 35.00 SEPT IC TANK.SEEPAGE PIT OR j P,C.NO. V PITS AN./OR DRAINFIELD CO.IMP.NO. JOB NO. 310.00 C HOUSE SEW ER CO NNECTIRST. TRUNK PERMIT NO. ROAD PERMITN O PRIVATE DISPOSAL SYSTEM $3.00 I� CONNECT ADDITIONAL BLDG.Oq AFFIDAVIT WAIVER EASEMENT RECORD.INSTR,NO. ATE W WGRKTO HO U SE SEWER @ 83.00 a POVERFLOWEEPAGE PIT,GRAINFIELDOL.DRYWELL,MANROLE Q 35.00 Z R OR ABANDON OUSE HWY. ST I MINGSPOSA FYS33.00 STATEENCROA M PERMIT NO.INDUSTRIAL WASTE APPROVAL CHARGES PERMIT sION TOTAL FEE A C CONNECTION CHARGE FEE I 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 INSPECTOR'5 SIGNATURE SIGNED THIS DAY OF-19— OW F19_OW HER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,BEL PITIB) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ANO/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING FLU ME ING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OW NEq AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE OV DE C B IDENTI PROP TY. ABANDON HOUSE SEWER SIGN I GNATURE BACK SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD CASH SUPERVISING MECHANICAL ENGINEER N, X07 6 5 9S MV30 1 1 A 2 5.00 °E°°° t°'°2 'ISA 08 1 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 15? GI JOHN A. LAMBIE. County Engineer ADDacss J a3 WILLIAM A. JENSEN. Supt of Building _ LOCALITY NEAREST FOR APPLICANT TO FILL IN CR SS ST. , ,,_LEGAL N .OWNER /`��j MAIL FACT V ADDRESS O. OF BLOCS. W ON LOT CITY TEL. NO. OISTRICT NO. GROUP MAP PROLES �Y BK PG^jam)jig TION DAATATEL / TION _D_EPTH _ ❑ MANHOL F FE E+CE {]G' UPPER } REGISTRATION NO. ❑ COUNTY d . DESCRIPTION O WORKFEE— NO TYPE OF CONNECT L GTH FROM ✓' O HOUSE SEWEa CONNECTING TO Y CURB Pl. .L TO P.L. V l/ PUBLICSEWER � $5.00 P,C.NO, D SEPTIC TANK.SEEPAGE PIT OR PITS AND/ pRAINFIELD � 510.00 CO.IMP.NO. � JOB NO. O HOUSE 5EWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT Ne PRIVATE DISPOSAL SYSTEM $3.00 W CONNECT ADOI TIONAL BLDG.OR AFFIDAVIT My II IRI RECORD. INSTR.NO. ATE a WORK TO HOUSE SEWER ® $3.00 N OVERFLOW 5EEPAGE PIT,ORAINFIELO EXTN_CESSPOO L,DRYW ELL,MANHOLE Q S5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDEN 5EWER OR DISPOSAL SYSTEM 83.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL ' OWNERS PERMIT E z 00 HARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER, DATE INSPECT 'S SIGNATURE SIGNED THIS DAY OF 19_ 4r-G T OWNER OR NEW HOUSE SEWER 6� OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SFIELEEP, IT(-) AN./.R pRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE E COMPLY f ; WITH ALL COUNTY RRDINA NCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORV WELL ❑ 1 HEREBY CERTIFY THAT IS PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER ORIt LICENSED AS REQUIRED BY LOS ANGLES COUNTY ANO STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEG OWNER OF. AND INTEND TO pI3CONNECT PLUG ANO RESIDE IN. TH V E FI CE �L PRO ERTY. J ABANDON HOUSE G AN SIGNATURE OF PERM ITTE BACKFILL SEPTIC TANKS SEEP.PITHS) ❑ CESSPOOLS ❑ CK. 0M. O, GSH VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER ;107 6 3 1-� OV 29 1 0 A 7.00 CI