HomeMy Public PortalAbout10756 LYNROSE ST_Sewer__ CR806 D I3-57 APPLICATION PERMIT
PERI`�
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING c
JOHN A. LANTBIE, CountyEngineer ADDRESS S
CASSATT D. GRIFFIN, Supof building ; y,
LOCALITY
LEGAL FOR APPLICANT TO FILA'. IN _CROS ST. e.
_ 3 u
1 (•:e t ...,. _J.".. 11 i. (::__i.�.?. '+s"Lei m
DESCRIPTION LOT NO. -L _ OWNER'
DLDCK TRACT MAIL
ADDRESS jM22 ,
NO.OF BLDGS, r
$171 OF LOT NOW ON LOT CITY ° t'' a tt TEL.HO: ' rr�
USE OF �n
BUILDINGS y-) ia..ent - DISTRICT NO. ` GROUP TRAP
PG
CONTRACTOR I
_ t
'ADDRESS .4��; c:�vv CONNECTION DATk
CITY n cx...._, TEL.NO. t..rl.;.+� FS 3� STATION d>'.'u -, .r "��' .,DEPTH
$
STATE. MANHOLE REFERENCE .�--;� r,',� -'
UPPER_ "
REGISTRATION h0 .-1. J COUNTY „sy. vdJiro„kir 1
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO �:.. ">
�'UELICSFWER 'q' $' ;ri`Q
St-PT iC TANK.SEEPAGE PIT OR - TYPE OF CONNECTIO; -"!�p LENGTH FROM
PITS AND/OR DRAINFIELD Y, CURIE p P L. M,L,TO P,L.
_ (g7 $u3,OO _ _
OVERFLOW SEEPAGE Pi'T,GRAINFIELD
I EXTN..CLSSPOOL,DRYtNELL,MAN HOLE Cel $2:00
HOUSE SEWER CONNECTING TO - P,C NO
PRIVATE DISPOSAL SYSTEM _ @p$1,00
CO,Ifr7P.N0_ .10E,'30.
' T ADDITIONAL,BLDG.OR.
WORK'TO HOUSE SEWER @ $I.00_ TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE - -
SEWER OR DISPOSAL.SYSTEM @ MOO STATE ENCROACHMENT
INDUSTRIAL
WASTE APPROVAL
-------------_---- - CHARGES
0WNER'S PERMIT 5 �OO� _CONNECTION CHARGE FEE�
ALITHORIZAnONt
TOTAL FEE REIMBURSEMENT EEE -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. -
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS 1 DATE iNSPEC72 SIGNATURE
TO THE PUBLIC SEWER,
SIGNED TI19v. __.._[JAY OF—.----I 9-- NEth HOUSE SEWER
OWNER. OR 1Y� I;, CONNECT ADDdTiONAL ��� -
OWNERS AGENT - RU!LDiNG OR WORK
ADDRESS--- SEPTIC TANK,SEEP„PIT(S)
_�— — _. AND/OR DRAINFIELD _
IH
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ^— --�
AND STATE THAT THE ABOVE 15 CORRECT AI10 AGREE I'0 COMPLY CESSPOOL i� DRYWELL 0
WITH ALI. COUNTY ORDINANCE'S AND STATE. LAWS REGULATINGPLUMBING A14D SETTERS. ALTER REPAIR SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/UR SEWAGE D SPOSAi SYSTEM
LICENSED AS REQUIRED BY LOS AU ELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM TME-k GAI,,OWNER OF THE APVE A9ANDON HOUSE SEWER �.
,DESCRIBED RESIDENTI,A PROPERI:-Y' - BACKFILL SEPTIC TANKS 0 -
afSEE`P.PIT(.$) ❑CESSPOOLS
SIGNATURE
OF PERMITTEE ---------------
VALIDATION ROBERT A. WOOD
CK, !d.0. CASHSUPERVISING MECHANICAL ENGINEER