HomeMy Public PortalAbout8855 HERMOSA DR_Sewer__ g8.s3—s5" e.
S&E-663 12-50 7 �-
° APPLICATION FOR P IMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER SEWAGE DISPOSAL
Department of County Engineer ${
County of Los Angeles AODRE8UILDSSG'1 �• H�/rl,/j�q,
WM.J. FOX. COUNTY ENGINEER /i
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
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_ FOR APPLICANT TO FILL IN NEAREST
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LEGAL / p OWNER 1I •AAGL( /1
DESCRIPTIO LOT NO. /3!
BLOCK /`oTRACT S174Q pAIL
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S RE35IJ
SIZE OF LO fix*oO f NOW ON LOTA
CITY y TEL. N0.
USE OF
BUILDINGS ���� DISTRICT NO. GROUP MAP
BK
CONTRACTOR
ADDRESS I / 5 J 5 CONNECTION DATA
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CITY TEL. NO.,f C a'[- /1' [' STATION Y3 DEPTH
❑ STATE J/ / ANHOLE REFERENCE
REGISTRATION NO. / 'r [! c (j COUNTY l J • LPl .YPP6M.'- LOWER
—/ , TYPE,OOION LENGTH FROM /
NO. DESCRIPTION OF WORK FEE Y URB P L N L TOP L
'HOUSE SEWER CONNECTING TO �4
PUBLIC SEWER Q S 3.50
HOUSE SEWER CONNECTING To
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR
WORK C HOUSE SEWER 1.00 CO. IMP. N0. I331D JOB. NO.
ALTER OR REPAIR V V
_ SEWER OR DISPOSAL SYSTEM M 1.00 TRUNK PERMIT N0. ROAD PERMIT N0. 0OOA bo
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM L00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
— CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION TOTAL FEE Q REIMBURSEMENT FEE
MED CON-
TRACTORTTO CONHIS NECT THE ABOVE CTED WDESCRIBED EXISTING ITH THE HEREIN A DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC EW R '
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SIGNED THIS DAY OF19�!(p NEW HOUSE SEWER
OWNER OR ✓ CONNECT ADDITIONAL
OWNERS AGENT \J _ BUILDING ORRWORK
1 w SND/OR
TANK, SEEP, PIT(S)
_ADDRESS - _�7 AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
PLUMBING AND SEWERS. ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCOHO USE SEW
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SOPSMC
CESSPOOLS - //r
SIGNATURED,r•A��-
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
By
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BY -I.,C.J, / is.4ti2 1'�tl / `I' 5.5C�
DEPUTY DEPUTY
BY BY $/
® DEPUTY �� _ - OEfOTY