HomeMy Public PortalAbout10112 NADINE ST_Sewer__ aaag s,,„ APPLICATION FOR PERMIT
DIVISION OF SUUDDFG AND SAFETY SEWER—SEWAGE DISPOSAL 1
Dowtaaent of County Engineer
County of Loe Angeles FADDRESS
DING a
JOHN A LAMBIE COUNTY ENGINEER
M CASSATT D GRIFFIN SUP T OF BUILDING LITY i
FOR APPLICANT TO M IN ass /S
LEGAL OWNER II
DESCRIPTION LOT NO
NAIL
BLOCK TRACT ADDRESS
NO OF SLOGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NOI 6� I MAP
BUILDINGS
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CONTRACTOR G. P. Constr. (��YY
CONNECTION DATA
ADDRESS r 'fCITY El Monte TEL NO Gi . &-9405STATION DEPTH PPER
MANHOLE REFERENCE
19 STATE
REGISTRATION NO 152P-71 ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO lowP L M L TOP L
PUBLIC SEWER @ $3 50
SEPTIC TANKSEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $300
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE ® S Z 00 CO IMP NOr JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM $I 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $t 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERM s 1 00
AUTHORIZATION TOTAL FEE
a REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT-A t SEPTIC TANK SEEP PIT(S)
LREg AND/OR DRAINFIELD
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
NG AND SEWERS SEWAGE DISPOSAL SYSTEM
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORDISCONNECT PLUG AND
ED ASREQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
RNIA OR THAT 1 THE LEGAL OWNER OF THE ABOVEED RESIDENTIAL OPERTY BACKFILL SEPTIC TANKS❑URESEEP PITS)❑ CESSPOOLS❑
RMITTEE
JOHN A LAMBIE Co TY E GINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
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