HomeMy Public PortalAbout10752 LYNROSE ST_Sewer__ C76A6426 E808 11-57 APPLICATION FOR PERMIT le
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BuWs, 7�52 !anLcse
JOHN A. LAMBIE, County Engineer ADD
CASSAW D. GRIFFIN, Supt of Building LOCALITY Tem'-ple, k,"."ity
TT NEAREST Live Call'-,
FOR APPLICANT TO FILL IN CROSS
LEGAL
DESCRIPTION LOT NO. OWNER "osagle Ii, 1JI Wcoo"
MAIL
BLOCK TRACT GL djJ
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY - o n-6 c, TEL.NO. Gi. 35P14
USE OF
BUILDINGS e s t DISTRICT NO. GROUP MAP
CONTRACTOR K PG
I
D U "'d_L f7> � ,j
i
ADDRESS Box 1208 CONNECTION DATA
8'7 0�4
CIT�'- dW—' n TEL.NO. STATION Z DEPTH
STATE MANHOLE REFERENCE UPPER
COUNTY LOWER
REGISTRATION NCr.L z
NO.1 HOUSE
OF WORK FEE
HOUSE SEWER CONNECTING TO -400
PUBLIC
LIC SEWER
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION - LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB M.L.TO P.L. ,
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE $2.00
I HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM $1.00 CO.IMP,No.
JOB No.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1,00
TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEINER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPRO AL
CHARGES
OWNERS PERMIT CONNECTION CHARGE FEE
WN 1"'00
AUTHORIZATION TOTAL FEE 5 00 REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS —_DAY OF---I 9— NEW HOUSE SEWER
OWNER OR eV?— CONNECT ADDITIONAL
OWNERS AGENT PUiLDING OR WORK
ADORES SEPNC TANK,SEEP,PIT(S)
ANDI 0 R DPAINFIELD
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AMD STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL[j
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT I ALM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGE1,ES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAI' I AM THE-1-EG&L OWNER OF -THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDE�,N�TIA4�:� OPERTY.-7 -;"
BACKFILL SEPTIC TANKS
SEEP. PIT(S)
SIGNATURE
I
F PERMIT PERMIT11.
VALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER