HomeMy Public PortalAbout8832 HERMOSA DR_Sewer__ BA6420-63D APPLICATION FOR PERMITfj jBO
CE808
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPO AL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt Of Building i
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS 5T.
LEGAL q / J
DESCRIPTION LOT NO. O y F OWNER .y ( 1 I
MAIL
BLOCK TRACT Z ADDRESS NO
SIZE OF LOT NOW DONE LOTS CITY TEL. NO.,?()'
O.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP P CESSED BY
/��] SEWER
a �)/� �} BK PG
CONTRACTOR ABLE SEWER NJ�LJI mTnyp � 3 /d� ~
ADDRESS
�[2 KlIng Pr man CONNECTION DATA
CITY SO. El Mont1e1 TEL. NO. -�6 �- STATIDN DEPTH
REGISTRATION NO. 219441 X STATE❑ COUNTY MANHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK FEE A-^ TYPE OF COy`tlE.FTI.NN O` (/[j LENGTH ROMHOUSE 5�WrR /
PUBLIC SEWER CONNECTING TO 55.00 U Y. CDUK. R.L. M.L.TO P.L. IS
�j
SEPTIC TANK.SEEPAGE PIT OR CO.IMP. NO. , ;f .J O J C NO, O
PITS ANO/OR GRAINFIELD R s10.00 JOB NO.
HOU EE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT J
PRIVATE DISPOSAL SYSTEM @ S3.00 /
/ CONNECT ADDITIONAL BLDG,OR AFFIDAVIT wAivu s[x[xi RECORD.INSTR.NO. DATE O
WORK TO HOUSE SEWER 83.00 F
OVERFLOW SEEPAGE PIT.DRAINFIELD W
EATN..CESSPOOL.DRYWELL.MAN H OLE® 55.00 d
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING N
SEWER OR O SPOSA SYSTEM 53.00 STATE ENCROACHMENT Z_
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT sz 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
Y HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAME. CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER, DATE INSPECT ',SIGNATURE
SIGNED THIS DAY OF G 19 'f �7w _
OWNER OR NEW HOUSE 5EWER
OW NERS AGENT y�
CONNECADDITIONAL
RWORK
BUILD IN G OR WORK
ADDRESS C�
BTANK,SEE P'
ANK.BEEP.PITS)
1 HEREBY ACKNOWLEDGE THAT HAVE HEAD THIS ACATION AN.D.//O.R DRAINFIELD
AND STATE THAT THE ABOVE ICORRECT AND AGREE TCOMPLY
WITH ALL COUNTY OR.INANCES AND STATE LAWS REGULATING GULATING
PLUMBING AND SEWERS, CESBPOOL ❑ ORYW ELL ❑
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 ORtA.
M THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE N. THEESCRIBED E5 ENTIAL PROPERTY, ABANDON HOUSE SEWER
RE
SIGNATU
OF PERMITTEE BACKFILL SEPTIC TANK S ❑ f
SEEP.PIT(B) ❑ CESSPOOLS / fly �1L2,:M
- CALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M,0. CASH
LfSGo 8 1 JAN 18 1 U A 1 0.0 O" p