HomeMy Public PortalAbout9107 HERMOSA DR_Sewer__ t
A69APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE—DISPOSAL
.. Deportment of County Engineer
County of Los Angeles BUILDING ..� L' ]ejl
WM. J. FOX, COUNTY ENGINEER ADDRESS KNivwD!t'
CASSATT'O.-GRIFFIN:SUPT OF'BUILDING LOCALITTFOR APPLICANT TO FILL IN NEARESTCROSLEGALDESCRIPTION LOT N0. 7XSOWNERBLOCK TRACTOMAIL
�y ADDRESS D / �P/W�
t L NOW O BLOTS. CITY TEL. NO.W[J
512E OF LOT�D l J0 NOW F LOT
USE OF - GG
BUILDINGS �J'•
DISTRICT 110. GROUP MAP
IS
CONTRACTOR / P�
ADDRESS CONNECTION DATA
CITY, AL.
STATION
—ATIONT7 n - DEPTH r r
❑ STATE l/ MANHOLE REFERE
REGISTRATION NO. / ❑ COUNTY .?./ UPPER ✓�/' h 1BMMlR
C r
Y TYPE O URB NEC OP.L. MEL GTO P L. --/
No. DESCRIPTION OF WORK FEE
�
,HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 G HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. /R JOB. 140.
WORK TO HOUSE SEWER 1.00 _ l �/ y
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK.SEEPAGE PIT OR
_ PITS AN GRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYW ELL WASTE APPROVAL
SPECIAL CONOITIONS ONLY 2.00
CHAkG1P<
$ I DD
OWNER'S
PERMIT CONNECTION CHARGE FEE
_
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED LING 9PPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC §EWE5
SIGNED THISDAY OF 19441-Ma— , NEW HOUSE SEWER
OWNER- OR - /WI�'"JK UV J�� , CONNECT ADDITIONAL 7
OWNERS AGENT,j /SIL' !/L �p BUILDING OR WORK
ADDP S$ ID A d+ �%+�1i7M/1�'ML L� (' SEPTIC TANK.SEEP, PIT(S)
:AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLICATION / CESSPOOL❑ DRY'WELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER. REPAIR.SEWER OR
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA-OR THAT-1 AM THE LEGAL OWNER OFTHEABOVE -ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC.TANKS 11
..SEEP. PIT(S)
IT(5) ❑. CESSPOOLS
SIGNATURE
'
OF-PERMITTEE—
WILLIAM
FPERMITTEE WILLIAM J. FOX, COUNTY ENGINEER- - - VALIDATION
_,ACO4s52_7P JUN' 9 4.5 0m.'.
DEPUTY; DEPUTY
BY BY
,'® DEPUTY DEPUTY