HomeMy Public PortalAbout10761 LYNROSE ST_Sewer__ CE6U8 15-37
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUI
JOHN A. LAMBM. County Enainser A D I t1j!t,,,?61 1yrc__-,e, 21 r-ee-
CASSATT D. GRIFFIN. Supt of Building T
LOCALITem1,-,)1e Cjdt;-�
j NEAREST j 'a
FOR APPLICANT'TC) FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. -a C S e e ni n ot 1'Uc �I`l
–OWNER
BLOCK TRACT 2 4 MAIL
ADDRESS RESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY 111 11c'ut e TEL.NO, Gia3 14
USE OF I
BUILDINGS DISTRICT NO. GROUP MAP
PG
CONTRACTOR La D. 81rr Const-rucv1 on Co -), �:�7
-08 — q _�?r ZLI
ADDRESS "X- ,',
CITY T.,_Lcvan 1- iarx CONNECTION DATA
TEL.N0. �!�d STATION DEPTH
113 6 17 STATE MANHOLE REFERENCE ---_tkoii4_
REGISTRATION NO. COUNTY 2r A' '
'5 ?,
�?4,,—.:g, -,
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER - xacxxw,x, -';3'1 0 TYPE OF CONNECTION[_,;-,j. LENGTH FROM
SEPTIC TANK'SEEPAGE PIT OR
PITS AND/ORDRAINFIELD @ $3.00 Y. CURB (�'–p-L • M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFiELD
EX N.,CESSPOOL,DRYWELL,MANHOLE @ $Z,00
—
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 a $1.00
TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL CHARGES
OWNER'S PERMIT $ 00 CONNECTION CHARGE FEE
T-
AUTHORIZATION I—TOTAL FEE 5 100 REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS 1. DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THISDAYOF_—I q_ NEW HOUSE SEWER
OWNER OR 'T CONNECT ADDITIONAL
4DW14ERS BUILDING OR WORK
ADDRESS— SEPTIC TANK,SEEP,PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT 'I'HE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Fj DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I E CERTIFY THAT I AM PROPERLY REGISTERED ANWOR SEWAGE DISPOSAL SYSTEM
H REBY Y AND STAT OF F
LICENSED AS REQUIRED BY LOS ANG�LES COUNT DISCONNECT LUG AND
CALIFORNIA OR THAT I AM THE: LJiGAL OWNER OF THE AOVE ABANDON HOUSE SEWER
DESCRIBED RES!DENTIAJ;�PROPERTY BACKFILL SEPTIC TANKS [I
Z'
SIGNATURE SEEP. PIT(S) [I CESSPOOLS E]
OF PERMITTEEref
VALIDATION ROBERT A. WOOD
CK. At.0. CASH SUPERVISING MECHANICAL ENGINEER