HomeMy Public PortalAbout10036 LYNROSE ST_Sewer__ D
cE808 - APPLICATION. FOR PERMIT- -
eeoa a-ss COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AUL'SG ' ,
CAS ATT D.JOHN A. GRIFFIN, Supt of Engineer
'/
D D
Building-. l i "� '
JLOCALI�Y
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL ,/� OWNER
DESCRIPTION LOT NO. L/
- ' {MAIL
BLOCK., TRACTADDRESS ALV-�.lt,t.�
/16 1'
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT �• CITY ���(?" TEL. NO.
USE DI tA�t DISTRICT NO. GROUP - MAP PROCESSED BY
�. ,Z
BUILDINGS �•1�'1LX1. i � •� BK PG
CONTRACTOR ! '✓' (l� ' s
ADDRESS �?7 I �� ''. ,,�, CONNECTION DATA.
CITY i'�; �'j�: - TEL.N0. �"U .`3 STATION / /� yDEPTH
I7'`� ' Tr� /� .
REGISTRATION NO. j_. �� C l- (�"•t ® COUNTY MANHOLE REFERENCE _ UPPER
LOWER
NO. DESCRIPTION OF WORK FEE f+
'HOUSE SEWER'CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE F CONNECTION LENGTH FRO.Iri'
SEPTIC TANK,SEEPAGE PIT OR Y. CURij P.L. M.L.TO P"..I!�.'
ITS AND/OR DRAINFIELD @-$3.00 -
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.. CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO R
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. JOB NO.
. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0." OAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER, Rt.�N HOUSE STATE ENCROACHMEN
SEWER OR-BtqP&9*+-�EM @ $1.00 PERMIT NO.
INDUSTRIAL f _
WASTE APPROVAL`
CHARGES
OWNER'S PERM $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT.FEE
i HAVE AT DATE A CONTRACT WITH THE NAMED CON-
TRACTOR TCIDESCRIBEDONNECT THE ABOVE SCRIBED EXISTING O NG DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER._ -
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL _ _ -
OWNERS AGENT - BUILDING OR WORK
ADDRESS - SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1. HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND 'AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER:REPAIR,SEWER OR
- SEWAGE DISPOSAL SYSTEM ' -�' L-'Y
1 .HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RES�,p L PROPERTY,., BACKFILL SEPTIC TANKS Cl
(, ( /{ SEEP.PITS) ❑ CESSPOOLS ❑
SIGNATURE ; -1__. .
OF PERMITTE 4
FVALIDATION
- = ROBERT A.-'WOOD _
'
CK. M.o, cpsR SUPERVISING MECHANICAL ENGINEER
A14 :86 1 0 A3-00.