HomeMy Public PortalAbout8909 HERMOSA DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEDER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY T-
BUILDING NEAREST
ADDRESS 89n 9 , '�, ' CROSS ST. /( ,ENO ST
LOCALITY DISTRICT NO. I SERIAL NO. PERMIT NO.
NEAREST
CROSS ST.nn II(/Z„¢,/)/j.Q _—I .f.� (/ RECEIVED BY Ready for Inspection DATE ISSUED
OWNER 02t'' � 4A�.a'e` 1.4
MAIL
ADDRESS
T$lO�'9 Cid—� +P/L1'�!}(S�-��'�✓J,.JL . � � I USEZONE OCCUPANCY ByKJ MAP PG
CITY L
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CO.IMP.NO. /_ 3 Q
1 ADDRESSST, / JOB NO. f
CITY �, TEL.No.�Lry CP/� /jQ`1 TRUNK.P`RMIT NO,
> ❑ STATE
REGISTRATION TION H0. p y �J❑ COU NTV; ROAD PERMIT NO,
DESCRIPTION LOT NO. c/ 9 ��L ,O s ,n' PERMIT NO.
ROACHMENT\ /
BLOCK TRACT v 9 Q I{ i INDUSTRIAL
WASTE APPROVAL ](
SIZE OF LOTSG �,� AO NOW ON LOTS I ,16HARG ES
USE OF
BUILDINGS �[� CONNECTION CHARGE FEE `\
NO. DESCRIPTION OF WORK FEEHOUSE REIMBURSEMENT FEE \ -
I PUBLICSEWEgCONNECTING TO 0S 3.50 -AJry RECfIPT NO. I DATE IBY\
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED \
WORK TO HOUSE SEWER 1.00 I
PATE I - 8Y
ALTER OR REPAIR EXISTING N0. \:
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER - -
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR '
PITS ANO/OR GRAINFIELD 2.00 STATION 4 DEPTH G
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 CS/ MANHOFERENCE LOg ER`
_ TYPEOFCONKECTION LENGTH FROM
OWNERS PERMIT $ I 00 Y. CURB J P.L. M.L.TO P.L. `{n
)E
AUTHORIZATION TOTAL FEE �'7J
4
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR 170 CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR' SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_----tv.__._DAY OF_.... .. ....19-4-S NEW HOUSE SEWER
OWNER � `
0It /� �Vln<� CONNECT ADDITIONAL
OWNERS AGENT._..___........_.....-_.........._.'.._.t"K..-G BUILDING OR WORK (/
p CSI' �j�� _R_ _____.T__ SEPTIC TANK,SEEP.PIT(S)/
ADDRESS. .{.'�_._..................._.. ._._. ...._.... ..._...._._... AND/OR DRAINFIELD i
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL E] DRYWELL�
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED /
ANO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
DISCONNECT PLUG ABANDON HOUSESAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)� CESSPOOLS f2"
OF PERMITTEE. _. ...._.._....
._..y/_L......:_.._.._............._..._.__..._
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