HomeMy Public PortalAbout9811 HOWLAND DR_Sewer__ CEBOB 3.83 APPLICATION' FOR PERMIT
TeABAZD COUNTY OF LOS ANGELES _
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSA l!
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAREST
FOR APPLIC T TO FILL IN CROSS ST.
LEGAL /
(dDESCRIPTION LOT 7 OWNER
MAIL
BLOCK TRACT � (//! wDpgE55
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY I TEL. NO.
USE OF DISTRICT NO. GROUP MAP CESSED BY
BUILDINGS
BK PG
CONTRwCTOR __
ADDRESS / ' CONNECTION DATA
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CITY `/•YY TEL. NO. 7 SPL/J3''/=j"
UPPER
REGISTRATION NO. COUNTY MANHOLE REFERENCE ,
NO, DESCRIPTION OF WORN FEE TYPE OF ION LENGTH FROM
HOUSE SEWER CONNECTING TO O Y. CURB P.L. M.L.TO PT. a
PUBLIC SEWER 0 $5.00 _s O
SEPTIC TANK.SEEPAGE PIT OR P C NO,
PITS ANO/OR ORAINFI E LD @ S10.00 CO. IMP.NO. JOB NO. / V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO, ROAD PERMIT N C O O
PRIVATE DISPOSAL SYSTEM It $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT III IIw[ HEGORD.INSTR.NO. DATE
WORK TO HOUSE SEWER 0 $3.00
OVERFLOW SEEPAGE PIT.GRAINFIELD
E%TN_CESSPOOL.DRYWELL.MANHOLE 0 $5,00
ALTER.REPAIR OR ABANDON HOUSE HWY,OR ST.WIDENING y
SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT L
PERMIT NO.
INDUSTRIAL -
WASTE APPROVAL
OWNER'S PE$ PE5 z o0 CHARGES
AUTHORIZATION TOTAL FEE v C\ ONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COl/N- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC 5 R. APPROVALS DfTE / INSPECTOR:5 SIGNATURE
SIGNED THISD F
OW NER OR ���./f NEW HOVSE SEW ER
OWNERS AGENT/ CONNECT ADDITIONAL A
wODRE55_ C
BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AN. STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORVWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REOVIREO BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THELE L OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB DESCRI ED ESIOENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGN4TV RE r
OF PERMITTEE BACKFILL SEPTIC TANKS ❑ `I
SEEP.PIT I51 ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
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