HomeMy Public PortalAbout10751 LYNROSE ST_Sewer__ 765420
CE", APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUI LD
JOHN A. LAMBIE, County Engineer ADDR& 751 Lyurose stre-et-
CASSATT D. GRIFFM, Supt of Building ' — "' ' 1 11 *4-',
I LOC I mple uluj
FOR APPLICANT TO FILL IN —1 ve Cak
LEGAL Construction.
DESCRIPTION LOT NO. 10 OWNER'L't.
1),LL7'y�Q MAIL
10227� ijovrer Azusa R"ca.G,
TRACT f . ,) '0BLOCK A DRESSNO.OF BLDGS. 'r"" J SIZE OF LOT NOW ON LOT CITY j,.I-L Llcn be, TEL.NO. Gj,
USE OF dent DISTRICT NO. GROUP MAP
BUILDINGS zte 2-2, PG
CONTRACTOR L.D. C',cnE%t-.t,i1 c j o-i-I
ADDRESSBC)x x''08 CONNECTION DATA
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-'Par.k, TEL.NO. 8- �24 DEPTH
CITY ' STATION
STATE MANHOLE REFERENCE UPPER
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REGISTRATION NO. -i 751 FD 1.3 COUNTY
NO. ! DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 4)x 00
5-EPTIC TANK.SEEPAGE_PIT OR TYPE OF CDNNECTION, , LENGTH FROM
AND/OR DRAINNELD @ $3.00 Y. CURB 4P.L. M.L.TO P.L.
UVERELOW SEEPAGE PIT,ORAfNFIELD
CESSPOOL,DRYWELL,MANHOLE Q $2.00
HOUSE SEWER CONNECTING TO 1 P.C.NO,
PRIVATE DISPOSAL SYSTEM @ $1.00 I Co.IMP.NO.
JOB NO. 5.
CONNECT ADDITIONAL BLDG.OR
WORK.TO HOUSE @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
AL'T'ER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM cd $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUS-TRIAL
WASTE APPROVAL
— CHARGES
OWNER'S PERMIT s 'A'�00 CONNECTION CHARGE FEE
AUTHORIZATION' TOTAL FEE 00 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DATE
__�ATINSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS_ _DAY OF_---_ .—t 9-- NEW HOUSE SEWER
OWNER OR — CONNECT ADDITIONAL
OWNERS AGENT 1,;i e 51 BUILDING OR WORK
ADDRESS- SEPTIC TANK, SEE?,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT 'THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
_�jE',��AGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT j AM 'rHZ--4,EGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER
DESCRIBED RESMENTW'4ROPF� TY,, j BACKFILL SEPTIC TANKS Fj
SIGNATURE SEEP.PIT(S) [I CESSPOOLS
OF PERMITTEE— 4
VALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
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