HomeMy Public PortalAbout9149 HERMOSA DR_Sewer__ E808
C AG4 ID-53 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBHi, County Engineer ADDRESS
WILLIAM A. JENSEN. Sup'1 of Building
LOCALITY
NEAREST
FOR APPLICANT TO FML IN `ROSS ST.
EGAL //p
DESCRIPTION LOT NO. OWNER 1
[ MAIL
BLOCH TRwCT ADDRESS
NO. OF BLDGS.
S12E OF LOT NOW ON LOT CITY TEL. NO
USE OF DISTRICT NO. GROUP MAP PROCESSE BY
INGS
BUILD
0K /PG
CONTRACTOR A3,
ADDRE COECTION DATA
CITY TEL. NO. �/ STATION 1SNNDEPTH
ATE S PP
MANHOLE REFERENCE /�
REGISTRATION NO. ❑ COUNTY [., LOWER
NO. CESCRIPTI N OF WORR FEE TYPE OF TION LENGTH FROM
HOUSE SEWER CONNECTING TO h� Y. CURB P.L. M.L.TO P.L.
PU BLIC SEW Efl 85.00 V /� PC NO B.
SEPTIC TANK,S EE PAGE PIT OR 5 y'
PITS ANO/OR DRAINFIELO 310.00 CO.IMP. NO, JOB NO. O
V
HOVATE 01SE POSAL CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE SYSTEM ® X3.00
CONNECT ADDITIONAL BLDG.OR I AFFIDAVIT wgvq u5[K[xi RECORD.INSTR0
.NO. DATE O
WORK TO HOUSE SEWER X3.00 r
OVERFLOW SEEPAGE WELL. AIN FIELE VW
ALTN_C REPAIR OR ABANDON AN HOHOUSE � $5.00 0.
ALTER, REPAIR OR ABANDON HOUSE � HWY.OR BY,WIDENING Z
SEWER OR DISPOSAL SYSTEM ® X3.00 STATE ENCROACHMENT _
T
T NO.
TRIAL
E APPROVAL
CHARGES
OWNERS PERMIT s z
AUTHORIZATION TOTAL FEE ECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPEC DR'S SIGNATURE
SIGNED THIS DAY OF 19_ /��� /
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL r
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(5)
t HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO/OR DRAINFIELO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE.LEGAL OWNER.OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE E DE RIBED RE ENTIA PROPER
ABANDON HOUSE SEWER
SIGNATURE BEEP. IT SEPTIC) ElTANKS ❑ q+.P u�
OF PERMITTEE_ BEEP.PL (S) ❑ CESSPOOLS V��1
VALIDATION ROBERT; WOOD SUPERVISING MECHANICAL ENGINEER
CK.
M.0. CASH
LAGo8 0 9 1' APR18 1 0 D 7.00-
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