HomeMy Public PortalAbout9025 HERMOSA DR_Sewer__ 78A8420APPLICATION FOR PERMIT 1
5&E.669 II.SS
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County- Engineer
County of Los Angeles BUILDING !^/ q }
JOHN A. LAMBIE. COUNTY ENGINEER ADD R E55 'y'l' ,-.. -1l 4 n,p Q
® CASSATT D. GRIFFIN, SUPT of BULLVINa LOCALITYT/-'-
FOR APPLICANT TO FILLEGA LL IN .....B sT. (n <e YYl c L
DESCRIPTION LOT'NO. 3 OWNER
MAIL
BLOCK - TRACT . 90- ADDRNO. OF ESS
SIZE OF LOT j—O ��O NOW DN LOTS / CITY A - TEL. NO.
USE OF
BUILD'
- DISTRICT NO. GROUP MAP
USE
BK
IS
CONTRACTOR- O .`
L Z P�
r CONNECTION DATA
ADDRESS L��T �..1
lye v � C STATION DEPTH
CITY [_ 111 TEL. N0. y f- ,� MANHOLE REFERENCE _ _ UPPER
REGISTRATION NO. J �(7 7 L] COON LOWER
.
No. DESCRIPTION OF WORK F E
HOUSE SEWER CONNECTING TO-:-- - - - _ TYPE OF CONNECTION - - --LENGTH FROM - - -
PUBLIC SEWER • @ 5 3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ 5 3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. NO. -
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ b 2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q S 1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR �Y STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 Qv PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE - INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ChI $1.00 WASTE APPROVAL '
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE
AUTHORIZATION xOTAL FEE 00
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL z
OWNER OR. BUILDING OR.WORK D
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR.DRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
.AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGALTER,REPAIR.SEWER OR
"PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Oft DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGEL`S CO TY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM' THE 'LEGAL N R OF THE ABOVE
DESCRIBED RESIDEN PROPS TY. `� l ' .BACKFILL SEPTIC TANKS❑
SIGNATURE �T� SEEP. PIT.(5) . CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER / VALIDATION ROBERT.A. WOOD. CHIEF PLBG. INSPECTOR
NO. ASN "
5 0 1 E FEB 1 l 4 3 .0 0 n