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Home My Public Portal About8755 HERMOSA DR_Sewer__ LJ. 76A 662D - CE806 - 9/73 APPLICA1 N FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUIL 7_1�S LOCALITY FOR APPLICANT TO FILL IN CROSSSST. I DESCRPTION LOT NO. i—a L OWNER MAIL BLOCK TRACT ADDRESS y NOW OON LOTS CIT ' TEL. NO. SIZE F LOT 0 /� USE OF BUILDINGS DISTRICT NO.1 GROUP I MAP PRINESSED BT BK P1 CONTRACTOR ��j p �I _/ 1/� ADDRESS Vp ^ CONNECTION DATA/ CITY TEL. NO. yy J-7 �� STATION — /�3 7A DEPTH STATE �hlr /�_� LIC MANHOLE LREEFERENCE {{{000 UPPER LICENSE NO, `60 4 GLASS �LCq£R NO. DESCRIPTION OF WORK FEE TYPE OF�COTNNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CybH� -P.L. M.L.TO P.L. L PUBLIC SEWER Q $7.00 zv SEPTIC TANK.SEEPAGE PIT OR P.C.NO. PITS ANO/OR DRAINFI ELD Q EIO.00 CO.IMP, NO. JDB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVIRI.S[NIFi RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER ® $3.00 6 OVERFLOW SEEPAGE PIT.GRAINFIELD Q E%TN..CEGSPOOL.DRYWELL. (11 $5.00 U ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM ® $3,00--- 3.00 STATE ENCROACHMENT � MANHOLE Q $7.00 PERMIT NO. V INDUSTRIAL W 1 WASTE APPROVAL N Z OWNERCHARGESS pERMTT s 3 00� CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE '� I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EX15TING DWELLING APPROVALS TO THE PUBLIC SEWS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY � 19� OWNER OR NEW HOUSE SEWER OWNERS AGENT �� CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP.PIT(b) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL Cl IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNT NG ST E OF SEWAGE DISPOSAL SYSTEM CALIFCPNIA OR THAT 1 THE LEGAL O ER O ND IN D TO RESIDE IN. THE ABO EGCR ED RES TIA P ABANDDgSCONECT PLUG AN ABANDON HOUSE SEW ER 5IGNATURE OF PECMTTTEE BACKFILLS),F TANKS ❑ SEEP.PIT IB) E6SPOOLS 01 1 ,VALIDATION cK.' M.D. CASH � J. 7 6 6i`FEB 11 1 U u 1 0.0 0 Ate„ 47 76A 6410 -CE8I6-1041 APPLICATI FOR 1' tR' MIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 7 j ADDRESS LOCALITY NEAREST FOR APPLICANT TO FILL IN CRO55 ST LEGAL DESCRIPTION LOT NO. DIANE MAIL BLOCK TRACT Q � ADORE NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP BN MAP q ESSED BY Pi CONTRACTOR ADDRESS ,Z I /// �E''') CONNECTION DATA CITY STATE /./ ''TJJEL. NO, Yq/ 5-9 7� STATION _27'� 2 _ DEPTH LICENSE NO VOO GY'SIJ-I GLP5513 �1 UPPER MANHOLE REFERENCE P 4 I 6,01111"INR NO. DESCRIPTION OF WORK FEETYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO T. � M.L.TO P.L. 3O � PUBLIC SEWER 0 S7.00 P.C.NO. SEPTIC TAN //�N K.SEEPAGE PIT OR CO. IMP. NO. J�EJ POB NO. PITS AND/OR DHAINFIELD ® SIO,00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. G. PRIVATE DISPOSAL SYSTEM 43.00 TRUNK CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I wAtv[RSEMEN RECORD.INSTR,NO, DATE U WORK TO HOUSE SEWER ® 33.00 OVERFLOW SEEPAGE PIT.DRAINFIELD Y. E%TN..CESSPOOL,ORYWELL. HWY.OR ST.WIDENING O -- "' ABANDON HOUSE F- SEWEROR�E@EPSALSYSTEM Q $3.00 4A ST ATE ENCROAC XMENT yVj MANHOLE ® $7.00PERMIT NO. D_ INDUSTRIAL WASTE APPROVAL OWNERS PERMIT E 3 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE GEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DES CR BED E%ISTING DWELLING APPROVALS TO THE PUBLIC SEWS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAV OF I9_�4 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PITIS) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION gND/OR DRAINiIELO AND STATE THAT THE ABOVE IS CORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS. CESSPOOL ❑ ORYW ELL 1 HEREBY CERTIFY THAT M PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COVN V AND STATE OF SEWAGE D45POSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL O NER AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A E ESCNI EO HELI T P TY. ABANDON HOUSE SEWER SIGNATURE OF PERMRTE BACKFILL SEPTIC TANK$ ❑ SEEP.PITIS) ❑ SSPOOLS ❑ VALIDATION cK. M.G. CASH 1 9._4kDEC 19 IJ •D/J � 6.0 0 ,yd