HomeMy Public PortalAbout10787 LYNROSE ST_Sewer__ 750,642
CF808 r)11-57 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUI NG' T
AD
JOHN A. LAM IL County Engineer
CASSATT D. GRIFFIN, Sup t of Building T
LOCALITY
NEAREST
FOR APPLICANT TO F111 IN CROSS ST.
en
LEGALry .c s,e:2
DESCRIPTION LOT NO. OWNER
,4(:7QQ
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS. 7,
TEL.NO. -
SIZE OF LOT NOW ON LOT CITY
USE OF d en t DISTRICT NO. GROUP MAP
BUILDINGS '11 t'_c�� I
F'
LEGAL 7A
L
DESCRIPTION E-5 IPTIO!_
BLOCK
_�17E 0 F LOT
U E 0
B U I L"
F- N GOS
CONTRACTOR 1.1 7. CcnsUri.-C G
CON
(n FnTTe)m DATA
[ADDRESS
CI I STATION DEPTH ell
CITY TEL.NO.
T
STATE MANHOLE REFERENCE UPPLR
va,
REGISTRATION NO. COUNTY
DESCR[PTION OF NORK FEE
HOUSE SEWER CONNECTING TO
i PUBLIC SEWER _3 OfO
TYPE OF CONNECTIONS":* LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR P.L.
PITS AND/OR DRAINFIFLD @ $3.00 Y. CURB M.L.TO P. .
OVERFLOW SEEPAGF PIT,DRAINTTELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
_PRIVATE DISPOSAL SYSTEM Q $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 0 $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL CHARGES
OWNER'S PERMIT $ �OO 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 DA.TE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THISDAYOF---I 9- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT BUILDING OR WORK
ADDRESS___�� SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ TI-115 APPLICATION
AND STATE THAT THE ABOVE IS 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 BY LOS ANG46'EES COUNTY AND STATE' OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM rIir,-_LEAL,OWNER OF THE A14OVE _-LB-AN-DONHOUSE SEWER
.
DESCRIBED RESIDENTIA1,,?ROPgxTY1, BACKFILL SEPTIC TANKS 0
SIGNATURE SEEP. PIT(S) 0 CESSPOOLS
OF PERMITTEE
VALIDATION ROBERT A. WOOD
U.0. CASH SUPERVISING MECHANICAL ENGINEER