HomeMy Public PortalAbout10755 LYNROSE ST_Sewer__ 76AI54210�
CE808 11-57 MI
APPLICATION FOR PERT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, County Engineer ADIXSS�&�'�' t
CASSATT D. GRIFFIN, Supt of Building
LOCALITY
NEAREST j
FOR APPLICANT TO FILL IN CROSS ST. 7ive c)ak
LEGAL
DESCRIPTION LOT NO. 9 OWNER
LC T-uza 7,cad
ADDRESS
FBLOCK TRACT NO.OF BLDGS. MAIL I'l -
SIZE
TEL.No. Gi. 14
-SIZE OF LOT NOW ON LOT CITY K
USE
SE OFU
I
BUILDINGS e n DISTRICT NO. GROUP MAP
I K
CONTRACTOR u. :D). J7C" PG
6f k
ADDRESSI —08 CONNECTION
")
CITYBaldwin rar- TELL.No. d., 37,024 24
STATION DEPTH
STATE
MANHOLE REFERENCE
REGISTRATION NO. COUNTY UPPER
No. J_DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER
SEPTIC TANK,SEEPAGE?I TYPE OF CONNLENGTH FROM
T OR
PITS AND/OR RAINLIELO 0 $3.00 Y. CU M.L.TO P,L.
OVERFLOW SEEPAGE PIT DRAINFIELD
—__E�XTN.,CESSFOOI.,DRYWELL,M.ANHOLr @ $2.00
HOUSE SEWER CONNECTING TO P.C. NO.
".NO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM $1.00 STATE ENCROACHMENT
FERMIT NO.
INDUSTRIAL
WASTE APPROVAL
-CHARGES
ONEWS PERMT CONNECTION CHARGE FEE
W
AUTHORIZATION TOTAL FEE c 00�1 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF__-I NEW HOUSE SEWER
OWNER OR L, -i w CONNECT ADDITIONAL
OWNERS AGENT —BUILDING OR WORK
ADORES SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL(:1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM TILE JXGAL' OWNEROF THE A�dVE _ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL. T,-f
._PR9PER ,. BACKFILL SEPTIC TANKS Ej
NATURE z
SEEP.PIT(S) 0 CESSPOOLS 0
SIGNATURE
PERMITTEF.':�__
VALIDATION ROBERT A. WOOD
CK. R.0. CASH SUPERVI.$ING MECHANICAL ENGINEER