Loading...
HomeMy Public PortalAbout8845 HERMOSA DR_Sewer__ 0&&-2D 66 APPLICATION FOR PERMIT 1 e 4 6. 1 1.55 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING ! JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS m CASSATT D. GRIFFIN. SUWT o•BUILDING LOCALITY 0 , OR APPLICANT TO FILL IN CROSS ST. LEGAL nQC . , DESCRIPTION OWNER BLOCK {�O MAIL ADDRESS I a NO. OF SLOGS. CITY SIZE OF LOT ` NOW ON LOT USE OF -'w BSE OF GB., /d/. q��� DISTRICT N0. GROUP MAP CONTRACTOR K I J'PG[/ ADDRESS �j / 7r S CONNECTION DATA STATION C:1 10' DEPTH ' CITY /�� TEL. NO. L— CJ �rL-1/ G'U Ss MANHOLE REFERENCE UPPER ) REGISTRATION N0. / C/ e-- C1 STATE �a ❑T COUNTY No. DESCRIPTION OF ORK FEE PUBLIC SEWER @ S 3.50 _ � Y. TYPE OF Ue i TIONP L MEL GTOH P`OM HOUSE SEWER CONNECTING TO J SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELDP. C. NO. EXTN.,CESSPOOL,DRYWELL.MANHOLE ((41 S 2.00 CO. IMP. NO. j[3 1013 NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM © S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. IG-- CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER (Il1 $1.00 -'� PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM G $1.00 WASTE APPROVAL CHARGES _ CONNECTION CHARGE FEE OWNER'S PERMIT s 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE } 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED N- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING (� TO THE PUBLIC SE 4ER. - NEW HOUSE SEWER SIGNED THI DAY OF194J..Ip CONNECT ADDITIONAL OWNER 00. 11 • BUILDING OR WORK OWNERS AGENT l SEPTIC TANK,SEEP,PIT(5) ADDRESS AND/OR DRAINFIELD IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL L3DRYWELL❑ 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 1 AM PROPERLY REGISTERED ANO/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 RESIDENTI P OPERTY. BACKFILLi0119ftOM ORRE SIGNATURE �!/j. 1190 IN CESSPOOLS OF PERMITTEE JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLI3G. INSPECTOR CR. N. 0. CASH it2 9 6 9,� oFr 3 4 5.50in