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HomeMy Public PortalAbout10520 LYNROSE ST_Sewer__ E808 8I sAs42Dazr� APPLICATION FOR P7!}ER11i IT COUNTY OF LOS ANGELS SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOIN A. LAMBIE, County Engineer ADDRESS /1-3� WILLIAMA. IEIdSEI�i. Hup't at Building LOCALITY NEAREST �H "PUC T4 FILL IN CROSS ST; A LEGAL } DESCRIPTION LOT NO. ' -�^ OWNER BLMAIL acle TRACT ADDRESS 1 0.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL NO. USE OF DISTRICT NO. GRDtlP MAP FR.QC SSE9 H BUILDINGS _ HtC PG a CONTRACTOR !7 — s{ + p ` `! y' ; ADDRESS yp ��' ,5 a _ ±p/'•.� CONNECTION DATA CITY ( r I /TEL NO. e d 4 STATION l DEPTH 6- ' + E!, STATE MANHOLE REFER CE REGISTRATION NO. LJ COUNTY g LasNER NO. I DESCRIPTION OF W RFBF p HOUSE SEWER CQNNECTINVIs TO a PUBLIC S£WdER - �' S •OO 1} ����-' TYPE OFCONNIO .ECTts. -`�, LENGTH FII0111. - SEP?IC TANK,SEEPAGE PIT OR Y. CURB P L, M.L.TO P,L. PITS AND/OR DRAINFIELD C, S..00 - OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL,DRY ELL 54.00 r— HOUSE SEWER CONNECTING TO P.C.NO, ✓' 0 PRIVATE DISPOSAL SYSTEM t 5.00 CO.IMP.NO. ,808 N0, � =u �J CONNECT ADDITIONAL BLD a,6YR WORK TO HOUSE SEWER � S ,00 TRUNK PERMIT N0. ROAD PERMIT N0. AL?ER,REPAIR OR ABANDON HOUSE I. STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM PERMIT NO. INDUSTRIAL D.. WASTE APPROVAL _ _ CHARGES z OWNEWS . PERMIT a 00 CONNECTION CHARGE FEE aTHORZAMN TOTAL FEE Jz I✓;.' r REIMBURSEMENT FEE TRACTOAT O THIS THE ATBOVE DESCRIBED HEREIN NAMED DWELLING APPROV= DATE INSPECTOR'S SIGNA'T'URE 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 Iii 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 ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 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 I AM THE LEGAL OWNER Of THE ABOVE BACKFILL SEPTIC TANKS 0SIGNATURE DESCRIBED RESIDERTIA�, PROPERTY SEEP,P1T(S © CESSPOOLS - J`: OF PERMIT?E VAUDA710N ROBERT A. WOOD CIL it.0, "SH SUPERVISING MECHANICAL TeNG18vK1'R