HomeMy Public PortalAbout9014 HERMOSA DR_Sewer__ 2D D
s&E-611.95 APPLICATION FOR PERMIT 1
9 e 6.
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING G➢'pf
.JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUIT OF BUILDING LOCALIT
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL I OWNER
DESCRIPTION LOT NO. 7'Y
MAIL
BLOCK G� TRACT [['� `/ AD ESS
SIZE OF LOT
/• /p _ NOW ON LOT 10E CITY- TEL. NO 1k 6 8
USE OF
BUILD,
DISTRICT NO. GROUP MAP
USE
7 B PG
CONTRACTOR L� ,1
ADDRESS �!✓ leU, F w T CONNECTION DATA
STATION Si Ni DEPTH
CITY _'T L4 TEL. NO. d (} � �� 7 �� MANHOLE REFERENCE
REGISTRATION NO �'3�`� ��-_y1 ❑ SZQpµVy 3C" ' LOWER
NO. 1 DESCRIPTION OF WORK FEE _
HOUSE SEWER CONNECTING TO
Y TYPE OF C TION P.L. LENGTH P.L.
LNTH M
/�
RB
PUBLIC SEWER @ $3.SO b '''
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ 53.00
OVERFLOW SEEPAGE PIT. L,MIN HELD CO. IMP. NO. � y IDB NOD
OVERFLOW
PIT. DRAINFIELD
52.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Cry S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ S 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT 5 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. _ NEW HOUSE SEWER
SIGNED THIS DAY OF 9p CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HA E READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY T ED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES UNTY A STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THA . AM THE LEGA 0 O T E AB VE ,I-
DESCRIBED RESIDE A OPER T / SEEP.FPIT($,ILL PO CESSPOOTIC TANKS L5�[J
SIGNATURE _
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER ^VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
LK. M.O. LASH
_103 1 7 O'Lc A'1C 3 4 +.�