HomeMy Public PortalAbout9169 HERMOSA DR_Sewer__ DEPARTMENT Or COUNTY ENGINEERSEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES '
WILLIAM J. FOX, COUNTY ENGINEER I BUILDIRESNG
ADDS
FOR APPLICANT TO FILL IN LOCALITY � T
BUILDING - / �q NEAREST V
ADDRESS (�`7 �/ 0 a CROSS ST. (� _
LOCALITY DISTRICT N0. SERIAL NO. ,( PERMIT NO.
NEAREST A�����a yyy ./�A� V A % `bb�j
CROSSST.�yyy--- f//gV gEC IVEO BY Ready for inspection DATEISSUED
OWNER ,
MAIL �� 1 •,/� hO USEZONE I OCCUPANCY BK MAP PG
AD ORE55 -/.-- �6 / 6)la
CITY / TELNO.4t4� �' I
CONTRACTOOR.([/e/ ��/ [ /Q,(}{�J(��/ CO.IMP.N0. j _ q LyL A
ADDRESS( .�, / DO'C-.lT(`/ _S4_^I• ) —�
14X,n JOB.N0.
CITY 44Y 0l� T,,ELLAO. 9.31,3 ,j'' TRUNK PERMIT NO.
REGISTRATION N0. /�� 7')"'� COUNTY ROAD PERP41T NO.LEGAL
DESCRIPTION LOT NO. �� STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT �/ INDUSTRIAL
WASTE APPROVAL
SIZE OF L07,�Z'J %�.,(�-D NO.
OW�OJN LOT 8 / CHARGE
USOF
BUILDINGS I0w r,kj-"( /" C7
CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 4D $ 3.50 RECEIPTNO. DATE ISY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION 6 ECO RO ED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' 0TE I BY
SEWER OR DISPOSAL SYSTEM 1.00 1
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR i
PITS AND/OR GRAINFIELD 2.00 STATION •/ � Z'� DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �/ i( "/ MANHOLE '- / A4 LOWER
TYPE OF TI
CONNE ON LENGTH FROM /
OWNERS PERMIT $ I 00 S`— CURB Etas' N.L.TO P.L. S
AUTHORIZATION I TOTAL FEE a —
NAMED
CONTRACTOHAVEIR TO CONN CT THEDATE CONTE ABOVE DESCRIBEDWITH THEI EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..¢y.-�`2_.__..DAY OF..;��..._...__.._..14 �� NEW HOUSE SEWER 1 ye, Gl<
OWNER OR C ,�.��4 . CONNECT ADDITIONAL
OWNERS AGENT,_......._......_....._........_._.._......_.._.._..____.__._..._. BUILDINGTANK WORK
�'(� '' � SEPTICTANK,DRAT FIELD IT(S)
ADDRESS..............._.........._..............._......_.._.._.....__.._._�5.............. AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPBOL[j DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.-REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT P AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND
AND STATE OF CA ORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOV SCRIBED RESIDE TI L PROPERTY. BACKFILLSEPTIC TANKS I] i
SIGNATURE a//�,� _ SEEP.PIT(S)Q CESSPOOLSERI SC'A oe'l 's -f _'r0
OF PERMITTEE.. ... -`� "- � �"-'-"`�`✓`�
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