HomeMy Public PortalAbout10783 LYNROSE ST_Sewer__ 18A6426
CEBaa 1f-87APPLICATION FOR PERMIT,
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B
JOHN A. LAXIBIE. County Engineer A Du -L-vn-L,c-,.-je 'Street
CASSATT D. GRIFFIN, Supt of Building LOCALITY ITY "era-ple Gty
EAREST
FOR APPLICANT TO FILL IN CNR SS ST..
LEGAL c- n. c lluc orl "Co
-DESCRIPTION LOT NO, 3 OWNER 0 e,- c'�-c
AIL
BLOCK TRACT f:�4579 AD Road
NO.OF BLDGS.
SIZE OF LOT NOW ON LOTS
OT CITY TEL.No. G—J 5(1,14
USE OF 711
BUILDINGS-a'�� -L %vii.c; DISTRICT NO. GROUP MAP
PG
CONTRACTOR -L. D. Cc-
t ru c- c,_,) C
LA
ADDRESS Pox 208 CONNECTION DATA
CITy1" TEL.NO. STATION DEPTH
11371 —
3 STATE. MANHOLE REFERENCE —i� UPPER
REGISTRATION NO, LJ- COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO - -v
� 77T
PUBLIC SEWER V1. �c U— -
SEPTIC TANK,SEEPAGE,PIT OR TYPE OF CONNECTIOtj.,-- LENGTH FROM
_PITS Y� CURB
ANA/OR DRAINFIELD $3.00 P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00
CO.IMP.NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR
�
WORK TO HOUSE SEWER @ $1.00±ALTER,REPAIR OR ABANDON HOUSE TRUNK PERMIT NO. ROAD PERMIT NO.
SEWER OR DISPOSAL SYSTEM 0 $1.00 STATE ENCROACHMENT
PERMIT NO,
INDUSTRIAL
WASTE APPROVAL CHARGES
OWNER'S PERMIT $ 00 CONNECTION 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 D I NSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THISDAYOF— 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS— SEPTIC TANK,SEEPPIS)
AND/OR DRAINFIELbT(
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL 0
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 81 LOS LES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE L GAL OWNER OF THE ABOVE --LI-1AN—DON H-0U-sLs—EwER
DESCRIBED RESIDENTIAL ;PROPERTY. BACKFILL SEPTIC TANKS El
SIGNATURE SEEP.PIT(S) El CESSPOOLS 0
OF PERMITT
'—VALIDATION ROBERT A. WOOD
CK, lw.0. CASH SUPERVISING MECHANICAL ENGINEER