HomeMy Public PortalAbout8747 HERMOSA DR_Sewer__ 76A 6420 - CE608 - 9/73 APP CATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BULGING `
ADDRESS
LOCALITY I--e
NEAREST
FOR APPLICAN TO FILL IN =ROSS ST.
EGAL
DESCRIPTION IGT NO. V OWNER
MAIL
BLOCK TRACT 14 f V AGGRESS /_ L
SIZE OF LOT
T /�I INOW ON LOTB CITY TEL. NO. L �2-7-7`-
USE DI DISTRICT N0, GROUP MAP q SSED BY
BUILDINGS
BK PS
CONTRACTOR •y �O r/Q
ADDRESS rC O �{�y(J q I CONNECTION DATA
[5-/177'-- STATION DEPTH • �^/
UPPER
LIC ENSTA TeSE NO. O�✓LJ V✓r( OL Ss `� MANHOLE REFERENCEAl.-6 LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO .Y _ CURB P.L. M.L.TO P.L.
PUBLIC SEWER 0 $7.00 Q
3 P.C.N0.
SEPTIC(ANN,SEEPAGE PIT OR CO.IMP.NO. JOB NO.
PITS AND/OR GRAINFIELD 0 f10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. D ,6
PRIVATE DISPOSAL SYSTEM 0 53.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIIIIII (nf DII- RECORD,INSTR,NO. DATE Y
WORKTO H OUSE SEWER ® Z3.D0 4
OVERFLOW SEEPAGE PIT.GRAINFIELD U
E%TN.,CESSPOOL.DRYWELL. 0 '5.00 HWY.OR ST.WIDENING /1
ALTER.REPAIR OR ABANDON HOUSE • C
SEWER OR DISPOSAL SYSTEM 0 53.00 STATE ENCROACHMENT
MANHOLE 0 $7.00 PERMIT NO. W
INDUSTRIAL d
WASTE APPROVAL y
OWNER'S PERMIT f 3 00 CHARGES
AUTHORIZATION TOTAL FEE /00,1 CONNECTION CHARGE FEE
1 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 SErf R, r _ � DATE INSPECTOR-5 SIGNATURE
SIGNED THIS DAY �•� 19-2J� /
OWNER OR -� /yam NEW HOUSE SEWER
OW KERS AGENT C•�•� el A
CONNECT ADDITIONAL
ADDRESS 1 BUIlO1NG OR WORK
SEPTIC TANK.SEEP.PIT(S)
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY V11D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFC,NNIA OR THAT THE LEGAL OW OF, INTEN TO
RESIDE IN, THE AB OE CRI ED REST TIAL Efl DISCONNECT PLUG AND
P ABANDON HOUSE SEWER
SIGNATURE BAC KFILLSEPTICTANKS ❑
OF PE4MRTE ❑
BEEP.PIT I51 DOLS
VALIDATION CK. M.O. CASH
7 6 8i;FEB 11 1 U U 1 0,0 0 Abo