HomeMy Public PortalAbout8771 HERMOSA DR_Sewer__ S&E420 11�5g
.0° APPLICATION FOR PERMIT 1
S 4 6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of Ccn aty EngLI
County of Los Angeles BUILDINGc n -
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS )
® CASSATT D. GRIFFIN. SUP'T°P S.IL.IM. LOCALITY J
I
NEAREST
FOR LIAR' T F;LSIN CROSS ST.� x It
LEGAL !9VA-0 �'F=�J
DESCRIPTION LOT NO. Y' '/ OWNER MAIL
LVI�I
BLOCK TRACT ADDRESS
J N0. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LO
USE OF DISTRICT NO. GROUP MAP
BUILDINGS BK PG
CONTRACTOR / AA J^ /
noDREss CONNECTION DATA' !b'7
STATION DEPTH
CITY iJ„ TEL. NO MANHOLE REFERENCE
El STATE (P LOWER
REGISTRATION N0. / ❑ COUNTY
NO. .DESCRIPTION OF WORK
HOUSE SEWER CONNECTING TO TYPE OFC CiJON LENGTH FROM
Y. RB P.L. M.L. TO P,L.
PUBLIC SEWER @ $ 3.50 c�
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ $3.00 p
OVERFLOW SEEPAGE PIT, DRAINFIELD � N0�
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ 52.00 CO. IMP. NO. 1J {/1 JOe
HOUSE SEWER CONNECTING TO I a
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ 51.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ b 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATIONTOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER ��/' NEW HOUSE SEWER �- a
SIGNED THIS AY OF H 19� CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AG J SEPTIC TANK,SEEP, PIT(S)
ADDRESS c AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE 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
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 1 AM THE LEGAL OYFNER OF THE ABOVE
DESCRIBED RESIDENTIAL PERTY / BACKFILL SLTTR1wfwMB
SIGNATURE / S0 CESSPOOLS
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIO-pTy-� ROBERT A. WOOD. CHIEF PLIEG. INSPECTOR
GK. M.f LC1Csxi
3,9 7 5 II; JAN 8 4 450 in