HomeMy Public PortalAbout8763 HERMOSA DR_Sewer__ . °
S&E66
APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
70/
® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO LLe. CROSS ST
LEGAL OWNER
DESCRIPTION LOT NO
BLOCK TRACT MAIL
Q �S - ADDRESS
NO. OF SLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USED DISTRICT NO. GROUP MAP
BUILDING$ a.Af/
CONTRACTOR
z BK �o�
C. CONNECTION DATA
ADDRESS
rF 2-f
/ STATION DEPTH - (Q
CITY TEL. N0. - - (�(1 MANHOLE REFERENCE
STATE Q > OWER
REGISTRA N n ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF N TION .LENGTH FROM A I
PUBLIC SEWER @ $3.50 �O CUR Yg a M.L.TO P.L. V
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. NO.
EXTN..CESSPOOL,DRYWELL,MANHOLE @ $ 2.00 CO. IMP. N0. JOB NO.
ffHOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.1O
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 .>� PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AHED con- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DES RTSEO EXISTING DWELLING
TO THE PUBLIC S4t1SfB. NEW HOUSE SEWER C
SIGNED THIS�DAY OF 19 CONNECT ADDITIONAL -
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRES AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR HAT I M HE LE L OWNE THE BOJE
D ED ESID IA TY. ACKFILL
S AF OG CESSPOOLS -
E MTTTTTTTTE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION _,,,ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CASH
5 8 0 tar 9 4 5.5 C in