HomeMy Public PortalAbout9031 HERMOSA DR_Sewer__ 76A642D 0-63 APPLICATION FOR PERMIT
CE808
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER 1111111111113111
BUILDING AND SAFETY DIVISION nUt sass
LAMBIE. County Engineeh
JOHN A. r �f
WILLIAM A. IENSEN. Sup't of Building 6'
LOCALITY m / ,
NEAgEBT
FOR APPLICANT TO FILL IN GRDBB BT. A//7
LEGAL /y �/
DESCRIPTION LOT NO. ) �J OWNER �S/
d' MAIL
BLOCK TRACT 0 �` ADDRESS sh
NO. OF BLDGS.
S2E OF LOT NOW ON LOT CITY TEL. NO.
USE OF pISTRICT NO. GROUP MAP PROCESSED BV
BUILDINGS 461-
BN
77
CONTRACTOR ��� e..✓P� v I O 8
ADDRESS ' f� -j '� CONNECTION DATA
CITY TEL, NO. STATION DEPTH
❑ STATE UPPER
REGISTRATION NO. ❑ COUNTY MANHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO V. - CURS P.L. M.L.TO P.L. Y
PUBLIC SEWER ® $5.00 a
NO.NO.
SEPTIC TANK,SEEPAGE PIT DR JOB O
OB
PITS gNOIOR GRAINFIELD ® $10.00 CO.IM O. ���� v
PRIVATE DISPOSAL KPOSAL SYSTEM TO @ 33.00 'fmJNPERMIT NO. � O ROAD PERMIT NO. K
CONNECT ADDITIONAL 0
AFFIDAVIT 4v[R •[[N[ RECORp. INETR.NO. DATE
WORK TO HOUSE SEWER ® S3.00 IV•
OVERFLOW SEEPAGE PIT.DRAINFIE LD W
EXTN..CESSPOOL,DRYWELL,MANHOLE® 55.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING H
SEWER OR DISPOSAL SYSTEM ® S3OO STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERCHARGES
S PERMIT 5 z o0
CONNECTION CHARGE FEE
AUTHORIZATIONTOTAL FEE
'I HAVE 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 OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.BEEP.PITIS) , /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AN./OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ElDRYWELL C3
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED BY L ANGLES CO NTV AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM E LEGAL OWN OF, ANO INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE CRI E 1° IAL PROPER[Y.
A ABANDON HOUSE SEWER
SIGNATURE ❑
BACKFILL SEPTIC TANKS
OF PER E - - SEEP. PIT IS) ❑ CESSPOOLS ❑
LIDATION ROBERT A. WOOD
cK. M.o, cases SUPERVISING MECHANICAL ENGINEER
L;L�„2566� AUG 131 0 D 5.00- a
17-
6A642 0-53 APPLICATION FOR PERMIT
C E80 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUI LETO /t / �r ` .
IOHN A. LAMBIE, County Engineer ADORES. (i'
WILLIAM A.JENSEN, Sup'1 of Building
LOCFLRY
FOR APPLICANT TO FILL IN
NE RE
EGAL 6 ,^
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT � 9 67 ADDRESS ✓)
NO. OF BLOGB. ALL_
512E OF LOT NOW ON LOT I CITY TEL. NO.
USE OF, C DISTRICT NO. GROUP MAP PROCESSED BY
BV IL-1 /I
CONTRACTOR //v eL _/Ji /� r
5",o OK
E — - G(U' •-
ADDREss a '� if7 fIGJ�I/l�,/F�J �. '/CONNECTION DTATA
CITY ✓Q C TEL, NOC / / I STATION ! 3 � /—/ DEPTH
�• [iPPGiY•
REGISTRATION NO. I S /(� Q _` t COUNTY MANHOLE REFERENCE 7 T i�� WERT
NO. GESGR PTION OF WORK FEE TYPE OFCONN TION LENGTH FROM
C
NOUS E SEW ER CO NNECTING TO �y� K CURB, P.L. M.L.TO P.L. �S
PUBLIC
SEWER 0 $5.00 l] V V -
SEPTIC TANK.GSEEPAGE PIT OR
PITS ANO/OR RAINFIELD SIO.00 CO.IMP.NO. Z. JOB NO. 9O /CJ$JCEJ/ O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIV ATE DISP05AL SYSTEM $3.00 C
CONNECT
RK TO ADDITIONAL HOUSE SEWS BLDG.OR S3.O0 AFFIDAVIT wAIYr. rAsImIlr RECORD. INSTR.NO. DATE O
OVERFLOW SEEPAGE PIT,GRAINFIELD VrW
EXTN_CESSPOOL.DRYWELL,MANH O LE@ 55.00 p•
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING yI
SEWER OR DISPOSAL SYSTEM 53,00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTEAPPROVAL
OWNER'S PERMITs z 00 CHARGES
AUTHORIZATION TOTAL FEE –7CJ\ CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING OWEL41NG APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'SSIG NATURE
SIGNED THIS ��]] DAY OF 19_ �- -
OWNER OR ` d/ r ` lr\ v NEW HOUSE BEWER
OWNERSAGENT! IY L/L�VV/�VV// �LJI/��,���JJJIII///1111
�' -�---gyp CONNECT ADDITIONAL
WORNAL
BUILDING K.WORK
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP.PIT(S)
AND/OR GRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE COMPLY
WITH ALL COUNTY OgO1NANCES AND STATE LAWS REE GULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY NO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL O R O NO INTEND TO OIS[ONNECT PWG AND
RESIDE IN, THE ABOVE DES I.E. R TIA ROPERTYA ABANDON HOVSESEWER
SIGNATUREBACKFILL SEPTIC TANKS ElSia/�i
OF PERMITT V 7
SEEP.PITIS) ❑ CESSPOOLS
LIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
Lj ;o2 4 0 1'� AUG 10 1 0 D 7.0001
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