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Home My Public Portal About10621 LYNROSE ST_Sewer__ 76A8663 12-V,. - APPLICATION ■ O■ 1. PERMIT ■ ■ :;&E•56til DIVISION OF BUILDING AND SAFETY SEWER-S EWAG E DISPOSAL Department of County Engineer County of Los Angeles BUILDING # .; •^^-w WM.J. FOX. COUNTY ENGINEER ADDRESS d CASSA.TT D. GRIFFIN, SUPT OF BUILDINGJLOCALITY"� FOR LICANT TO FILL IN NEAREST CROSS ST. LEGAL DESCRIPTION- f LO'T N0. �.'� s, l _ OWNER � , �," ✓;,.. :.,. ,.� BLOCK TRACT - - MAIL ADDRESS s ,., ;f 110.OF BLDGS. SIZE OF LOT „p.,:. NOW ON LOT y CdT TEL,N©. U5E OF -.,r_._._----_. BUILDINGS �"' 4r.- D'.STRICT 0. ROUP �. M.A° f SK PG CONTRACTOR ADDRESS ,$° CONNECTION DATA CITY ^£-�.,�+. :I..,.Y. TEL.NO. 146m-' 4, STATION 's'..-. .6�' DEPTH .rj, -.__.... -STATE MANHOLE REFERENCE - REGISTRATION NO. ❑ COUNTY �..'' � �l,.j„j UPPER _LSdIY€4t� TYPE OF CONNE. TION LENGTH FROM —.. NO, ! DESCRIPTION OF WORK PEE `Y:. culla � L. M L To.P:L. _- HOUSE SEWER CONNECTING TO PUBLIC S_EWER $ 3.50 I HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 I -� --.----------. --- �.� CONNECT ADDI'TI^.,NAL BLDG. OR �I ( PLO', IMP. NO _I WORK 10 HOUSE SEWER 1.00 B. NO. > '.r JC 4 ALTER OR RE A!R E]f TING SEA I.;R �R D SPOSAL SYSTEM 1.00 I- TRUNK PERMIT NO,. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER �! AND/OR DISPOSAL SYSTEM 1,00 ---- STATE ENCROACHMENT T--- -��h.._. SEPTIC TANK SEEPAGE PIT OR PITS ANVOR GRAINFIELD 2.00 ! INDUSTRIAL CESSPOOL DRYWELL WASTE APPROVAL -- ----- SPECIAL CONDITIONS_ONLY 2.00 1 Ly1ARGES ----- --�� CONNECTION CHARGE FEE OVFNEWSPERIVLYT �s � 1 ; 00 -------� _. --— AUTHORIZATION TOTAL FEE� { � � REIMBURSEMENT FEE_ I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- _ APPIROVALS � DATE INS,' CTOP S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCR-1ppCED EXISTING DWELLING TO THE PUBLIC IEW C-R ;/1 �,�6”' - N NEW HOUSE SEWER SIGNED THI / DAY OF - 19___ �- '' '^- ----- --- CONNECT ADDITIONAL OWNER CR �Se �, OWNERS AGENT•. BUILDING OR WORK--° '""'?~' "" '�" - --- - - C- SEPTIC TANK SEEP,PIT($) A COR ;SS - � ' '... AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY .----- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWER$. SEWAGE DISPOSAL SYSTEM I HEREBY CERTII''Y THAT I AM PROPERLY REGISTERED ANDIOR DISCONNECT PLUG A.ND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFCRNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE _ DESCRIBED RESI{1E '"IAL PFgERTY. -BACKFILL SEPTIC TANKS I SEEP. PI'F(S) C3 CESSPOOLS0 �i SIGNATURE ! ''i...-ter;"• ,OF PERMITTEE WILLIAM J. FOX.COUNTY ENGINEER VALIDATION L"� BY DEPUTY DEPUTY BY BY '�" DEPUTY DEPUTY