HomeMy Public PortalAbout9067 HERMOSA DR_Sewer__ DEPARTMENT OF COUNTY-ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ABUDDRESILD 1,ES8 -
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��F jOqR A/PPLICAANNT TO FILL IN LOCALITY
BUILDING
ADDRESS yQ(� �J L / �/�rJ-JQ,f/fi NEAREST
CROSS ST.
LOCALITY /G�tJ7 DISTRICT NO. - SERIAL NO. - PERMIT NO.
NEAREST li � � . A 13445 �Dr45�
CROSS ST.
REC LVE Y - Ready for Inspection DATEISSUES-
OWNERMAIL
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ADDRESS 0067 �' f7�Crrnl alb USEZONE OCCUPANCY MAP
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CONTRACTOR ®/ g�'Co. . . 7 /-P
ADDRESSy
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CITYTJ�ale �/UTNE L(.N�.Oj.+ ��j 71'1g1 TRUNK PERMIT N0.
CJG.J�D�J COUP.TY J /
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REGISTRATION N0. ++jj - ROAD PERMIT N0. -'2 4 4 Q 4/ .
DESCRLEGIPTION LOT NO. Si STATE ENCROACHMEN �F 1J
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT /' y /` NO.DF BLDGS.
�JO•Y/✓ NOW ON LOT CHARGES
USE OF / /_'�jQ��
BUILDINGS J�+e�f'j/Y�/J�� PQ CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE - y
HOUSE SEWER CONNECTING TO �� REIMBURSEMENT FEE X
PUBLIC SEWER 0 $ 3.50 � _SL RECEIPT NO. DATE
HOUSE SEWER CONNECTING TO \ BY
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER - 1.00
ALTER OR REPAIR EXISTING NO' DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECTAND ABANDONSEWER -
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION73 DEPTH 16
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �q( MANHOLE REFERENCE
-- 9`L � • - (010/ LOWER
TYPE OF CON NECTI ON LENGTH FRO 2_1OWNERS
PERMIT S 1 00
CURB '-446— M.L.TO P.L.
AUTHORIZATION TOTAL FEE 4 SD
IHAVE THIS DATE CONTRACTED WITH THE HEHFIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS---L�....._._DAY OF..,_l'C.Cl.�r..............I�� NEW HOUSE SEWER
OWNER OR CONN ECT ADDITIONAL
OWNERS AGEN � BUILDING OR WORK
- _ - - - - SEPTIC TANK,SEEP.PIT(S)
ADDRESS......... ... . ---- -- - CLIZG2.FC1...._... AND/OR GRAINFIELD
—�—�
I HEREBY/ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL ORYWELL�
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER ORREGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I B PROPERLY REGISTERED DISCONNECT PLUG AND
AN LICENSED CALIFORNIA REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF VEDESCRIBED
OR THAT IAM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Ej
SIGNATURE SEEP.PIT(S)Q CESSPOOLS ��u/�I-
OF PERMITTEGL'GQCILO _.. eL_..
40A0420
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