HomeMy Public PortalAbout8756 HERMOSA DR_Sewer__ 96A0426D
APPLICATION FOR PERMIT - 1
9 a C4 11.99
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADORESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN cRoss sr.
LEGAL OWNER C (..tA p.�l
DESCRIPTION LOT N0,
MAI Lf/
BLOCK TRACT 1 / ADDRESS
TEL. NO BLd
SIZE OF LOT NOW ON LOTT CITY / f 1 S
USE OF DISTRICT NO. GROUP MAP
BUILDINGS
BK
P
CONTRACTOR C C ` 1449._�
CONNECTION DATA
ADDRESS �C , }K STATION w / �/ DEPTH e/ O
CITY TEL. NO. 6 5 MANHOLE REFERENCE
i p r UPPER
C`]� V/ L
REGISTRATION NO. / �� �� I LlCOUN COUNTY
NO. DESCRIPTION.OF WORK FEE TYPE OFCURB TION LENGTH FROM OO
HOUSE SEWER CONNECTING TO ^� Y. P.L. M.L. TO P.L.
_ PUBLIC SEWER @ $3.50
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $Z.00 CO. IMP. NO. / O 109 NO.HOUSE SEER
q y-
PRIVATE DISPOSAL SYSTEMG TO @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORN TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ g [.Do WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 Oo
AUTHORIZATION TOTAL FEE 41 1 v O REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS ' DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r7 i �J� _
TO THE PUBLIC S ` NEW HOUSE SEWER - 'TIi: `// CJ`
SIGNED THI i� p��yJOF l f 16 CONNECT ADDITIONAL
OWNER OR I%'v'ZZ. ./ BUILDING OR WORK
OWNERS AGENT_ I6:; SEPTIC TANK.SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY A NOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATEIT AT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL( OUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I A THE LEGAL 0 NER OF THE ABOVE
DESCRIBED RESIDENTIAL P OPERTY. BACKFILL SEPTIC TpNKs❑ )/
SIGNATURE r SEEP.PIT(SI ❑ CESSPOOLS /
OF PERMITTEE'
JOHN A. LAMBIE, CO NTY ENGINEER ,-�/ALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
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-_111.0. CAsx
1Co5 9 �� MAY 8 . 4 4.50 m