HomeMy Public PortalAbout8908 HERMOSA DR_Sewer__ dw C
CES08 1
76A6410_BP APPLICATION FOR PERMI
COUNTY OF LOS ANGELES SEWER-SEWAGE.DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BOILDING (�
JOHN A. LAMBIE. County Engineer
Supt ADDaSss / o /?Eg�yry-,J¢�
WILLIAM A. IENSEN, Sut of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN `ROSS ST. / 7
LEGAL //
DESCRIPTION LOTNO. /!jam J J() /dlj OWNER
^ p MAIL
BLOCK TRACT V J A', ADDRESS
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL..NO.
USE OF DISTRICT NO. GROUPJ MAP PROCESSED BY
BUILDINGS w ') O /Y'' BK PG
CONTRACTO CL.( f/ / .JJ LT :! 'yj
ADDRESS . -- �` ONNECTION DATA
CI Y
Aj&r� TEL. NO. _ rQJ STATION `�' -3 DEPTH
' / TATE --RE t
REGISTRATION NO. / /��/ �� �OpNTY MANHOLE REFERENCE � L' UPPER
NO. DESCRIPTION OF WORK FEE TYPE OF CO ION LENGTHFROM
HOU5E SEWER CONNECTING TO V. U P.L. M.L.TO P.L J `L O
I PU BLIC SEW ER $5,00 � � PC NO lJ
SEPTIC TANK.SEEPAGE PIT OR JOB NO,
CO.IMP. NO.
PITS PND/Ofl OR
INFIELD E10.00 K
HOV SE EEWERCONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. (jj A7
PRI VATEOISPOSALSYSTEM $3.00 / '9( c— O
CONNECTAODITIO NALBLDG.OR AFFIDAVIT I WAIVEI NSrMHH RECORD. NSTR.NO. DATE W
WORK TO HOUSE SEWER @ $3.00 a
OVERFLOW SEEPAGE PIT,ORAINFIELD '
EXTN..CESSPOOL.DRYWELL.MANHOLE $5.00 HWY. OR ST.WIDENING L
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT
PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $I z DD
AUTHORIZATION TOTAL FEE Y 00 CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE R1 BED EXISTING DWELLING
TO THE PUBLIC BEWFA. - APPROVALS DATE INSPFjCTOR-S NATURE
SIGNED THIS /f�?—D///,Y OF
OWNER OR �V _//_ NEW HOUSE SEWER �/a '✓S
OWNERS AGENT UUVLLL 6%LlC/I
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH15 APPLICATION SEPTIC TANK.SEEP.PIT(S)
AND/OR DRAINFIELFIELO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DgYW ELt ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICEN5ED AS REQUIRE p V L05 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I THE GAL OWNER OF, INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AS ESCRI RESIDENTIAL P ERTY.
G° ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP,PIT(5) ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
CK. ..0. /c�SH ✓) SUPERVISING MECHANICAL ENGINEER
LJtI�3 2 9 4G DEC 9 1 0 D 7.0 0"