HomeMy Public PortalAbout8820-8822 HERMOSA DR_Sewer__ CEBGB 3.52 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDInc
TORN A. LAMBLE. County Engineer ADDgess
WILLIAM A. JENSEN, Supt of Building
LOCALITY
/ NEAREST
FOR APPLICANT TO-FILL yIN `ROSS ST.
LEGAL .// 11 VOI� Jxe- �• .
DESCRIPr1oN LOT NO.'Y[✓L1/ '•� /.s'�3 jjf! OWNER c/O y/54 �1` P eSAI
-,_,a ✓ MAIL i1�J a �✓
BLOCK TRACT ADORES$
NO. OF BLOCS.
SIZE OF LOT NOW ON LOT -ae CITY , TEL. NO.
USE OF —:;P /i M
BUILDINGS �J !" /J DISTRICT NO. GROUP MAP PROCE ED BY
"/ BK PG
CONTRACTOR .QucG�l'� _
/60
ADDRESS
y'/�O YG O,(ft,( � rj /CONNECTION DATA
/ �J.j�/C�TEL. NO.�/'yV �/ g STATION I V �I DEPTH
CITY ' ' �/� /C
������JJ//�� STATE MANHOLE REFERENCE
REGISTRATION NO. j - VG"[F`.>• COUNTY LOWE
NO. DESCRIPTION OF WORK FEE TYPE OF C ION LENGTH FRO }
HOUSE SEWER CONNECTING TO _ r• M Y. CV P.L. M.L.TO P.L.
PUBLIC SEWER ® 55.00 Cly [�F� 0.
SEPTIC TANK.SEEPAGE PIT OR l JOB NO PITS AND/OR DRAINFIELD EIO.00 CO.IMP. NO. (J JOB NO, V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NOO
PRIVATE DISPOSAL SYSTEM ® 33.00
CONNECT ADDITIONAL BLDG,OR AFFIDAVIT wMvu [as[w[x RECORD,INSTR. DATE
WORK TO HOUSE SEWER 53.00 3� ` �J[(Jp
OVERFLOW SEEPAGE PIT.GRAINFIELD
CJ V
E%TN.,CESSPOOL,ORYWELL.MANHOLE $5.00 y
ALTER,REPAIR OR ABANDON HOUSE HWY,OR ST.WIDENING !_
SEWER OR DISPOSAL SYSTEM "G. STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
1
OWNERS PERMIT s zI 00 CHARGES
O O6 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS FA; INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19e
OW NER OR NEW HOUSE SEWER � .�j)
OW NER.AGE •'��/
�i' / CONNECT ADDITIONAL
ADORESS� J _ BUILDING OR WORK
— .IC TANK.SEEP,PIT(5)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA AM THE LEG WHER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A V pESCR ESI(J–TIAL PROPEPyY, ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE BACKFILL SEPTIC TANK' ❑ ��' //
SEEP,PIT ISI ❑ CESSPOOLS 2✓
VALIDATION ROBERT A. WOOD
cK. M.C. CASH SUPERVISING MECHANICAL ENGINEER
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