HomeMy Public PortalAbout8902 HERMOSA DR_Sewer__ A&E-G. APPLICATION FOR PERMIT
s .°DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Depernnent of County Engineer
County of Los Angeles UILDING ADDgSS ESS
WM.J. FOX, COUNTY ENGINEER
CASSATT O. GRIFFIN, SUPT GF BUIL...G LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CgOSS ST.
LEGAL �L ...'vvv, r
DESCRIPTION LOT NOO F V OWNER
MAI
BLOCK TRACT ,j ADDRESS G�%Y
LLL NO. OF BLOBS. v C _y Q�L.v.V,� TEL. NO.
SIZE OF LOT, NOW ON LOT CITY
USE OF /
BUILDINGS DISTRICT NO. GROUP MAP
K PG
BI�
CONTRACTOR
ADDRESS I CONNECTION DATA
CITY e TEL. NO. STATION •� a /A 6 DEPTHSTATE (fl
MANHOLE REFERENCREFERENCEREGISTRATION NO. C ❑ COUNTY / 3 G
No. DESCRIPTION OF WORK FEE ! 01
HOUSE SEWER CONIIECTING TO TYPE NECTION LE
Y. CURB NGTH FROM
PUBLIC SEWER $ 3.50 V P.L M L TO P.L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM LOB _
CONNECT ADDITIONAL BLDG. OR / '7 J ANO.
V40RK TO HOUSE SEWER 1.00 �0 CO. IMP. NO. c7 t7 V JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
'DISCONNECT AND ABANDON SEWER ROACHMENT
STATE ENC
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NC
SEPTIC TA 11 K, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
S I o0
OWNER'S
PERMIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE TTOS CONNECTDATE ONTRTHEAABOVECTED WDESCR BED EXISTINGITH THE HEREIN A DWELLING MED CON APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER � !�
SIGNED THIS�_DAY OF G ' .I igi� NEW HOUSE SEWER _ �11 CM.,��
OlER R /� CONNECT ADDITIONAL
'lNERS AGE. VI a'•GI Li•"— BUILDING OR WORK
ADDRESS `�f 0 �t ,/�,1.(_A-(-R r 'f tL AND/ORSEPTIC TDRAINFEELD PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ORYWELL❑
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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNT D STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWN OF THE ABOVE ABANDON HOUSE SEWER.
DESCRIBED RESIDENTIALROPERTY. BACKFILL 9Yl
CESSPOOLSy-�6- �eh.v.✓
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX.CO Y ENGINEER ATION R.A. WOOD, CHIEF PLEIG. INSPECTOR
•`,_,O4 9 4 5 APR 10 4 5.5 D in