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Home My Public Portal About8729 HERMOSA DR_Sewer__ CEAp32O TSA592O 0-63 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION eUILDInG JOHN A. LAMBIE. County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building LOCALITY NEARE^ FOR APPLICANT TO FILL IN CRO LEGAL DESCRIPTION LOT NO. Q�' �� /I� ® OWNER MAIL [BLOCK TRACT ADDRESS O O NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF STRICT NO. GROUP MAP PROCE D BY BUILDIN nBK PG / CONTRACTOR � � ADDRESS CONNECTION DATA STATION 1 DEPTH/ �) CI STATE MANN OLREFS ENCS UPPEq REGISTRATION NO. CEOUNTY _ W � NO. 1 DESCRIPTION OF WORK FEE YPE OF CONNECTION LEN HFROM HOUSE SEWERCONNECTING TO � Y. CURB P.L. M.L.YO P.L. J PUBLIC SEWER ® 35.00 SEPTIC TPNK,SEEPAGE PIT OR .' P.C.NO. d PITS ANO/OR pRAINFI ELD ® SIO.00 CO. IMP. N. /� JOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.• / v PRIVATE DISPOSAL SYSTEM ® S3.00 (/^ � C OL CONNECT ADDITIONAL BLDG.OR AFFIDAVITe AIvn1 gSrxaxi RECORD. IHSTR.NO. DATE O WORK TO HOUSE SEWER ® $3.00 r OVERFLOW SEEPAGE PIT.DRAINFIEL.D /1 W EXTH..CE5SPOOL.DRYWELL.MAN H OLE® S5.00 HWY_SIRdT.-WIDE NGI / ;21 d ALTER.REPAIR OR ABANDON HOUSE TN SEWER OR DIBPOS AL SYSTEM ® $3.00 STATE ENCgOACNMINT PERMIT NO, INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 21 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 'I HAVE AT THIS DATE ACONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, APPROVALS DATE INSPECTOR'S SIGNATURE, SIGNED THIS 19 OWNER �' OWNER OR / , NEW MOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL / ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION gND/OR DRAINFIELO AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY WITN ALL COUNTY ORDINANCES S AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ OftYW ELL ❑ HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ R ALTER.REPAIR.SEWER OR LICENSE' AS REQUIRED LOS gNGLES COUNTY ANO STAT OF SEWAGE DISPOSAL SYSTEM CAL"FORMIA OR THAT I HE LEGAL OWN F. ANO NTE TO DISCONNECT PLUG AND RESIDE IN. THE ABOV D SCRIBED RESIDE L PPO RTY ABANDON HOUSE SEWER SI0 PEP PEFM E L BACKFILL SEPTIC TANKS ElOF ITTEE l ❑ CESSPOOLS ❑ ALI.0, I ROBERT WOOD CK. M.0, GSH SUPERVISING MECHAA L NICAENGINEER A642D 0-63 6APPLICATION FOR PERMIT CE808 COUNTY OF LOS ANGELES SEWER—SEWAGEISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION aulLDlrvc JOHN A. LAMBIE, County Engineer Do vREss WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST FOR APPLI T O FILL IN CRO55 S ,LEGAL DESCPIPTI ON LOT N" OWNER MAIL S '. J BLOCK TP y� AOOfl ESS (//�✓/ Jff NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. F O VBE BSE OF DISTRICT NO. GROUP MAP PROC rEO BY �PG /I A CONTRACTOR p/ G ADDRESS / CONNECTION DATA!!!/// CIT",j T O27 ST N DEPTH J STATEPPER REGISTRATION NO. O� COUNTY MANHOLE REFERENCE NO. DESCRIPTION OF WORK FEE TYP O bN_NECT ON LENGTH FR M HOUSE SEWED CONNECTING TO .0 RB' P.L. / M.L.TO P. s/ PUBLIC SEW ER ® 55.00 d SEPTIC TANK,5EEPAGE PIT OR P.C.NO. O CO.IMP. NO. I 3 JOB NO, v PITS ANO/OR GRAINFIELD ® 5I0.00 / Jn HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO/6� y PRIVATE DISPOSAL SYSTEM $3.00 / qy 0 CONNECT ADDITIONAL SLOG.OR AFFIDAVIT AIY[q IA11410T RECORD,INSTR.NO. DATE V` WORK TO HOUSE SEWER $3.00 )V, OVERFLO EEPAGE PIT.GRAINFIELD W E%TN„ 5 OOL,DRYWELL.MANHOLE @ 55.00 ALTE . PAIR OR ABANDON HOUSE H SEW OR DIFOSAOSWER, 43,00STATE ENCROACHMENT PERMIT NO, INDUSTRIAL WASTE APPROV AL CHARGES OWNERS PERMIT s AUTHORIZATION TOTAL FEE 6_0 CONNECTION CHARGE FEE 'IHAVE AT THIS DATE A CONTRACT WITH TH 14EIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCR D E%19T ING OW ELLINO TO THE PUBLICSE APPROVALS DATE I NSPECTOR'S SIGNATURE SIGNED THIS Y OF 19_ J OWNER OR NEW HOUSE SEWER (n,q OWNERS AGENT OOF CONNECT ADDITIONAL �♦ BUILDING OR WORK A ( )/ IV• ADDRESS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP.PITIS) AND/OR GRAINFIELD JYJJ f! 1 ANO STATE THAT THE 1DTNA 15 CORRECT AND AGREE COMPLY WITH ALL COUNTY DINANCES AND STATE LAWS REGULATING Ah/ J PLUMBING AND S R CESSPOOL ❑ DRYW ELL ❑ HEREBY C FY THAT AM PROP RLY REGIS REO AND/OR ALTER.REPAIR,SEWER OR LICENSED E PEO BY LOS A 5 COON Y AND STATE OF SEWAGE DISPOSAL SYSTEM U� I G LIFOLMITT R AT I AM THE L OWNER F wND INTEND TO RESIDE ROVE DT I AR IDE 4 ROPERT OIBGONNECT PLUG AND ABANDON HOUSE SEWERSIGNATOF PE BACKFILL SEPTIC TANKS ❑ P,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD CK. M.O. uSH SUPERVISING MECHANICAL ENGINEER L.'. ) 3762:. 1at1 , 11 A 2 5.0 J., r