HomeMy Public PortalAbout10777 LYNROSE ST_Sewer__ 7SA6420
CES08 11-57 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDSN
D� S
REA
JOHN A. LAMBIE, County Engineer AjDDRE', 777
CASSATT D. GRIFFIN, Supt of Building L TY
LOCALITY
7
� �Z
NEAREST 'r
FOR APPLICANT TO FILL INceos5 sr.
LEGAL 4 e'KC�"n�76:� U c'71 t. I
P'�
—DESCRIPTION LOT NO. - OWNER��
BLOCK TRACT 245'70 MAIL
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ADDRESS 10 j', Z U S' ,l 0 d
'CL
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY n TEL.NO.
USE OF --.-) I
BUILDINGSHe–,:iderit DISTRICT NO. GROUP MAP
iji). 'k': � . �:'C-nstructon a
CONTRACTOR . FG
ADDRESS CONNECTION DATA
r. 04
CITY Z',-
—TEL.NO. --a 3- 2STATION
DEPTH
STATE
COUNTY MANHOLE REFERENCE
REGISTRATION NO.
NO, DESCRIPTION OF WORK FEE Low�—R
HOUSE SEWER CONNECTING TO
PUBLIC SEWER
. .
$
c"c
SEPTIC TANK,SEEPAGE PIT OR
T. TYPE OF CCOUNNECTIO!�
kL� LENGT011pF.RL
OM
PITS AND/OR OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
E'T'.'CESSPOOL,DRYWELL,MANHOLE
@ $2,00
HOUSE SEWER CONNECTING TO $I.00 P.C.NO.
I L PRIVATE DISPOSAL SYSTEM Co.IMP,NO, JOB NO.
CONNECT ADDITIONAL BLDG.OR
_WORK TO HOUSE SEWER Q. $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.02-- STATE ENCROACHMENT
PERMIT NO,
INDUSTRIAL
WASTE APPROVAL CHARGES
OWNERS PERMIT 1CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE IINSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. —
-
SIGNED THIS-t)AY OF---- 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT— BUILDING OR WORK
ADDRESS-- SEPTIC TANK.SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER.OR
I HEREBY CERTIFY THAT I AM, PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM _
LICENSED AS REQUIRED BY LOS Af�.G-LES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE, L ABANDON HOUSE SEWER
DESCRIBED RESIDENT jAj,��, RQPERTY, �CZ OWNER OF THE ABOVE BACKFILL SEPTIC TANKS El
SIGNATURE,
--SEEP. PIT(S) 1 CESSPOOLS L-3 OF PERMITTEE
VALIDATION ROBERT A. WOOD
CK, M.P. CA$H SUPERVISING MECHANICAL ENGINEER