HomeMy Public PortalAbout9000 HERMOSA DR_Sewer__ 76A642D 0-63 APPLICATION FOR PERMIT
CE808
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
]OHN A. LAMBIE, County Engineer App H Ess —/ �Op � /
WILLIAM A. ]ENBEN, Supt of Building r— l
GCALiTV
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FOR APPLICANT TO FILL IN 8055 ST.
[AD,DtRESS
ON LOT NO. OWNER
MAIL
TRACT ADDRESS
NO. OF BLOGi ;/7/
OT NOW ON LOT CITY TEL. NfjM1
DISTRICT NO. GROUP MAP PROCESSED BY
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'✓♦ a(/ V/VI CONNECTION DATA
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STATE UPPER
MANHOLE REFERENCE
REGISTRATION NO. COUNTY LOWER
NO, OESCR TIO OF WORK FEE TYPE OFC CTION LENGTH FROM
HOUSE S EWEF CONNECTING TO I V. CURB P.L. M.L.TO P.L. }
PUBLIC SEWER 55.00 P.C.NO. d
SEPTIC TANK.5EEPAGE PIT OR CO. IMP, NO. B NO. O
PITS AND/OR ORAINFIELD 410.00 V
HOUSE SEWER CONNECTING TO TRUNK PER ROAD PER O.
PRIVATE DISPOSAL SYSTEM 53.00 C
POtVERFLOW
ONNECT ADDITIONAL BLDG.OR AFFIDAV uv usININi RECORD.IN5TR, NO, ATE O
ORKTO HOUSE SEWER 53.00 ` R V
SEEPAGE PIT.DRAINFIELD W
SPOOL.ORYWELL,M4NHOLE� 85.00EPAROR ABqN— HOUSE HV.OT.WIDENING
�5®l SYSTEM 53.00 STATE ENCROACHMENT Z
PERMIT NO.
IN
___TRIAL
WASTE APPROVAL
C ARGES
OWNERS PERMIT z z o0
AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE
IH AVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY / I 19
[OWN.F.ROR � j/J NEWHOU- SEWER
WESAGEN `� . CONNECT OR WIDNALKBVILpINGOR WORKSEPTICIEL. T(S)
HFRE ACKNOWLEDGE THA HAVE READ THIS [APPLICATION wND/OR DRgINFIELOANDIT ST E THAT THE ABOVE`I CONO S AND AGREE E COMPLY
ITH LCOUNTYORDINANCENDSTATE LwWS REGULATING/ CESSPOOL oRYWELLA PROPERLY REGISTERED gNO/OR ALTER, EPAI SEWER E ,nCENSED q5 R I ED/BY S ANGLES COUNTY ANO BTATE OF SEWAGE POSAL SYSTEM Yy§� /`„ DISCONNECT PLUG AND
ESIDE IN, THE R OE R EDEN TIgL PROPERTY. ABANDON HOUSE SEWER
GNATURE ❑
OF PERMITTEE / BACKFILLSEPTIC TANKS
SEEP,PIT(5) ❑ CESSPOOLS zUC
VALIDATION ROBERT WCrdU
SUPERVISING MECHANICAL ENGINEER
K. M,O. CASH
i fir. 3 0 1 2�- FEB 2 4 1 0 0 5.0 0