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HomeMy Public PortalAbout8810 HERMOSA DR_Sewer__ S E-663 11-3S APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer �j` p County of Los Angeles BUILDADDRESSING D REING )\1'/ Or F ' JOHN A. LAMBIE. COUNTY ENGINEER ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY Ter Le C,•Ty. CAL. F OR APPLICANT TO FILL IN NEAREST T. CA e LEGAL DESCRIPTION `LOT N0. / } F `. V OWNER p p SSaC/ J-r. y�M 0cm n 3(O/.J MAIL DD/d 4i C7�/1A10`Ia yRfVE BLOCK TRACT ADDRESS pp NO. ON LOT CITY OF BLDGS. S12E OF LOT NOW / f]` j e CST TEL. No A-1- T z e� xy��USOF ' BUILDINGS QS/ VONC DISTRICT NO. GROUP 'MAP BK PG CONTRACTOR _ ADDRESS j� CONNECTION DATA STATIONDEPTH J / CITY TEL. N0. MANHOLE REFERENCE ' 'o UPPER O ❑ STATE REGISTRATION N0. ❑ COUNTY No, DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO `�� TYPE OF/y�./ ��CTION LENGTH FROM PUBLIC SEWER @ $3.50 '`� M.L.TO P,L. OC ' SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR GRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. 1 JOB NO. HOUSE SEWER CONNECTING TO ) PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO./10/y 34J CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT f WORK TO HOUSE SEWER @ $I.00 'PERMIT NO. ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM a $100 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 1 00 S REIMBURSEMENT FEE AUTHORIZATION TOTAL-FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DES BIDED EXISTING DWELLING TO THE PONLIC 5EWE NEW HOUSE SEWER Q��_ ' SIGNED THIS AY OF 79 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) ADDRESS ® 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 ' I 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 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN IAL PROPERTY. BACKFILL SMiY`I�W�Q SIGNATUREQJJ _ CESSPOOLS110 � �� OF PERMITTEE kot JOHN A. LAMBIE. 9tOUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR '- -. cx. i_ 11348 CCT15 4 . 4.5 © m