HomeMy Public PortalAbout8836 HERMOSA DR_Sewer__ DE802.B.,, APPLICATION FOR PERMITI� 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 8836 -
ADDRESSMo8 _ QgE
88001 fopaz
.
]OHN A. LAMBIE, County Engine., 1✓
CASSATT D. GRIFFIN, Sup'1 of Building LOCALITY CA '�^ E'(
NEAREST
FOR APPLICANT TO FIL CROSS ST./L IN
LEAL
DESCRIPTION LOT NO. Ltl OWNER
BLOCK TRACT ' MAIL
ADDRESS
NO.OF,0O �6 4 NOW ON LOT S
SIZE OF LOT CITY TEL. N0.
USE OF Lv✓1 _L,.
BUILDINGS .JI/6� DISTRICT NO. GROUP MAP PROCESSED BY
S -t B! PG
y
CONTRACTOR
ADERE" ONNECTION DATA
WTY TEL. NO..)— STATION Sl: S DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. —COUNTY
OF WORK
NO. DESCRIPTION FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF C CTION LENGTH FROM
PITS ANO/OR ORAI NFIELD Q $3.00 Y. R P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
E%TN..CESSPOOL,DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TOC.
N0.
PRIVATE DISPOSAL SYSTEM !$ $1.00 CO.IMP. N0. JOB N0.
CONNECT ADDITIONAL BLDG.OR '�./� TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER fg $1.00 y
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT NO.
INDUSTRIAL 1 J
WASTE APPROVAL
CHARGES
74i
OWNERS P�MMIT S 2 00 CONNECTION CHA EE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF )g_ NEW HOUSE SEWER
CONNECT ADDITIONAL Y
OWNER OR „" / BUILDING OR WORK -/� ,/ f �l
OWNERS AGENT s� v 1
SEPTIC TANK, SEEP,PIT(S)
ADDRESS— AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑• DRYWELL❑
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 1 AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENT[ L PROPERTY. J SBf BACKFILL
4�1 .) f�S'SpOr i /S',�
SIGNATURE OLh - -
OF PERMITTE -
®e VALIDATION - ROB ERT A.WOOD
OK. Y.q, cASM BUPERYISING MECHANICAL ENGINEER
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