HomeMy Public PortalAbout10114 NADINE ST_Sewer__ 1
78A848D APPLICATION FOR PERMIT 1
88 B 08D 1MSION OF MUDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engmeer
County of Los Angeles FADDRESS
/ !
JOHN A LAMBIE COUNTY ENGINEER IF
CASSATT D GRIFFIN SUPsT OF BUILDING
FOR APPLICANT TO FILL IN CROSS ST
LEGAL n
DESCRIPTION LOT NO / fes' OWNER
NAIL
BLOCK TRACT ADDRESS
NO OF SLOGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE
BUILDINGS DISTRICT NO GROUP NAP
PG�CONTRACTOR6. i c g.I_ T
ADDRESSCONNECTION DATA
w
CITY M 0 TEL NO �V STATION /� v DEPTH
�J MANHOLE REFERENCE UPPER
645'STATE WE
REGISTRATION NO ,� /l ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CONNECT; LENGTH FROM
HOUSE SEWER CONNECTING TO e/� Y CURB P L M L TO P L D
PUBLIC SEWER Q $3 50 J
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL,MANHOLE @ $200 CO IMP NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER (io $1 00 PERMIT NO
ALTER REPAIR ORA BAANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMff s 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 4�01 ?743
I
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNAT RE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER A
SIGNED THIS D Y ZF 19 CONNECT ADDITIONAL
OWNER OR fot BUILDING OR WORK
OWNERS AGENT*'
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON NOOSE SEWER
CALIFORNIA OR THAT I AM HE LEGAL &ER OF THE ABOVE
DESCRIBED RESIDENTIAL P ERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE CTY E GINEER VALIDATION ROBERT A WOOD CHIEF PL13G INSPECTOR
Ar CK M 0 CASH
LM06 4 8 4- wR27 4 4.5 0 in