HomeMy Public PortalAbout9150 HERMOSA DR_Sewer__ ti
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E-B6 APPLICATION -FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING ,
JOHN A. LAMBIE COUNTY ENGINEER ADDRESS ]0'6
CASSATTD GRIFFIN. SUP T OF BUILDING LOCALITYNEARESTFOR APPLICANT TO FILL IN cRossT. �.11�2rLGi /L . OWNERDESCRIPTION LOT NO. / / MAILBLOCK- TRACT ADDRESSNO. OF BLDGS. `SIZE OF LOT NOW ON LO CITY TEL. NO.j
USE OF ,*w��� /
BUILDINGS. W. (,.` DISTRICT NO. GROUP MAP
CONTRACTOR / 3 •{: G.W „� ✓ �'L�.G
ADDRESS <7 ` CCO{'N�NECTION,DATA
.r �IV�I. .L f �.J ,I S '
CITY TEL. NO! L STATION DEPTH
MANHOLE REFERENCE UPP R
STATE OWER
REGISTRATION'NO. - � ❑ COUNTY
r No. DESCRIPTION OF WORK FEE
T HOUSE SEWER CONNECTING TO r� TYPE OF CONNECTION LENGTH.FROM
� ! PUBLIC SEWER @ $3.50 =(/ Y. CURB - P.L.x M.L. i0 P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,GRAINFIELD / �J P. C. N0.
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $2.00 CO. IMP. NO. "� / JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $I.00 TRUNK PERMIT NO ROAD PERMIT NO. -
CONNECTADDITIONALBLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER (<_1 $1.00 PERMIT.NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWERIOR'DISPOSALSYSTEM @ $L00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE GAS _
OWNER'S PERMIT S 7 00
AUTHORIZATION TOTAL FEE m REIMBURSEMENT FEE !
I HAVE AT THIS DATE A CONTRq CT WITH THE HEREIN NAMED CON= APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED E%[STING.DWELLING q�
TO THE PUBLIC SEyfR. �a/r, NEW HOUSE SEWER
SIGNED THIS DAY OF f'L 19 CONNECT ADDITIONAL
OWNER OR - �^'L�/ ��'�� `�• ��^� / _BUILDING OR.WOR K.
OWNERS-AGENT -� ,f [ GI
-SEPT IC TANK,SEEP,PIT(S)
ADDRESS 'AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONCESSPOOL ElDRYWELL LlAND STATE THAT:THE ABOVE. IS CORRECT.AND AGREE TO COMPLY-
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I
HEREBYCERTIFY THAT 1 AM PROPS LY REG I�SPE REO AND/OR DISCONNECT PLUG AND
LICENSED AB REQUIRED BY LOS ANGELES COUNyY AND STATE OF: ABANDON HOUSE SEWER
CALIFORNIA OR THAT SAM THE. LEGA OW ER OF THE ROVE.
DESCRIBED RESIDENT[ PROPERTY- BACKFILL SEPT I CTANKSOL❑-S
SIGNATURE. ] -SEEP. PIT(s) ❑ CESSPO1irTL EI
OFPERMITT �� '� Gi �
JOHN A. LAMBIE.'C
,OTY ENGINEER ( I:DJATION ROBERT A.WOOL). CHIEF PLG. INSPECTOR
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