HomeMy Public PortalAbout8731 HERMOSA DR_Sewer__ 6A642O 0-63 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONeLH En.
3I
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN. Supt o1 Building
OC ALITY
NEOREOT
FOR A LICANT FILL IN "°BS ST.
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DESCRIPTION L I OWNER
_ MAIL
BLOCK :IZ 7ADDECSS D
> N OF SLUGS. V
7 OC LOT G NOW ON LOT CITY -L. NO,
USE OF
BUILDING$ ) OISTRIGT NO. GROUP MAP PROCESS Y
� BK PG
CONTRAC Is -r—
ADDRESS
rADDRESS 2i _ CTION DATA
A�J 'V 1
CITY TEL. VfAXION DEPTH/1/"'/
EPPER
�f /) M LE REFERENCE
REGISTRATION NO. lo��+ OL-J ❑ COU ryTY
NO. DESCRIPTION OF WORK FEE TYPE PCTON LENGT FROM ✓
HOUSE SEWER CONNECTING TO {fLQU R�. � P.L. M.L.TO P.L.
PUBLICSEWER @ SS.00
SEPTIC TANK.SEEPAGE PIT OR P C NO. O
PITS AND/OR DRAINFIELD $1000 CO.IMP. N°. / JOB NO, V
HO U BE SEWER CONN ECTI NG TO TRUNK PERMIT NO. ROAD PERMIT NOA w
PRIVATE DISPOSAL SYSTEM @ S3GO x / /1
CONK TO AOOIT(ONW BLDG.OR AFFIpA VIT .11Y P L�-RECOR :'I H"< DATE VF
WORKTOH OUSE'.WAR $3.00 M r
OVERFLOW SEEPAGE PIT,GRAINFIELD
E%TN..CESSP°OL.ORYW ELL,MANHOLE 7 ;7-
SIFTER, /. d
R EPAI8OR ABANDON HOUSE 55.00 NWT. OR ST.WIDENING
OR DISPOS SYSTEM @ $3.00 STATE ENCROACHMENT
PERM( NO.
INDUS� AL �-^•
WA '^R O�VAt
s CHARGES
OWNERS PERMIT s
AUTHORIZATION I TOTAL FEE � lA CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED_COON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED E (STING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGNATURE r
SIGNED THIS ���]]]qqq Y F 19
OWNER OR � NEW HOUSE SEWER
OWNERS AGENT_��
ADDRESS CONNECT ADDITIONAL , 1),�
BUILDING OR WORK I I//' / 1/lAl
4
SEPTIC TANNIN EEP, PIT IS) ,{ ,I VI `
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/ORDRANFIELD /'J. � 1 r IA
ANp STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY OROINANDES AND STATE LAWS REGULATING ,h/DV I
PLUME
ING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR,SEWER OR
LICENSEE AS REOUIR' BY LOS ANGLES COON TY NO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH 1 M THE LEGAL NER OF, ND INTEND TO DISCONNECT PLUG No v
RES(OE IN, THE OV DESCR,.EO ENTI P ORE TY, ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE
SEEP.PIT I3J ❑ CESSPOOLS'❑
VALIDATION-----\ ROBERT A. WOOD
CH. M.p. CASH SUPERVISING MECHANICAL ENGINEER
wo W 7 7.x ±:1°; 1 ,1 1 1 A 2 5.0 0-
CE 308�i 0-83
75A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineer ADDRESS ��
WILLIAM A. JENSEN. Supt of Building /
LOCgLiTY
NEAREST
/ORP C. T GROSS sT.
LEGAL �+
DESCRIPTION L Y N _ OWNER !/
MAIL
BLOCK TRAC `^C 03 ADDRESS O •�
NO OF CLOGS.
SIZE OF LOT NOW ON LOT / CITY T.L. NO.
USE OF DISTRICT NO. GROUP MAP BK
7/2
O BY
BUILDINGS
CONTRACTS �� /y /1 �—)ADDRESS C /TNNECTION DATA
JJK��
CITY TE ION DEPTH /
STATE
REGISTRATION NO. O'_O ���� COUNTY MANHO FE ENCE I�` UPPIR
r(
NO. DESCRIPTION OF WORK FEE T F/ NEBTION LENGTH ROM
HOUSE SEWER CONNECTING TO j RB•LJ P.L. M.L.TO'P.L. �S
PUBLIC SEWER 55.00 UZ7 r
P.C.NO. It.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD SI0.00 CO.IMP. NO. JOB NO. O
NO U SE SEWER CONNECTING TO TRUNK PERMIT NO, ROAD PERMIT NO-
PRIVATE
v
PRIVATE DISPOSAL SYSTEM @ $3.00 (/QC. p[
CONNECT ADDITIONAL L.G.COR AFFIDAVIT My OluuxT RECORD, INSTR.NO, DATE
WORK TO HOUSE SEWER ® 53.00 O
OVERFLOW SEEPAGE PIT,DRAINFIELD w C5 V
E%TN.,CESSPOOL.DRYWELL.MANHOLE@ 55.00 IL
W
ALTER. PAIR OR ABANDON HOUSE HWY. OR S .WIOEN IN A y
SEWER ORER DISPOSAL SYSTEM � 53.00 I STATE• N ACHMEN i Y
PERMIT
INDUSTRIAL
WASTE APPROVAL
OWNER'S PERMIT $ z 00 CHARGES
AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE
'I ITAVE 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 INSPECTOR'S SIGNATURE
SIGNED THIS OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PIT 15)
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
I HEREBY CERTIFY 1 AM PROPERLY REGISTER D AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REOV ED Y LOS ANGLES COUNTY AN STATE OF SEWAGEO SPOSAL SYSTEM
CALIFORNIA OR T T 1 THE LEGAL OWNER OF. AN INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE OOVE DESCRIBED RE NTIAL RO ERTY.
ABANDON HOUSE SEWER
SIGNATURE BACEPPIT IBI ❑ CESSPOO
KFILL SEPTIC TANKS El PERMITTE ❑
SE . LS
VALIDATION ROBERT A. WOOD
cK. m.o. cnsH SUPERVISING MECHANICAL ENGINEER
LnDsU � � � ;r' 111CA 7'00 .
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