HomeMy Public PortalAbout10118 NADINE ST_Sewer__ D
aaa68811 D8 APPLICATION FOR PERMIT 1
8&66
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D 1 S POSA L
Dopar aaent Of Couatq Engineer
County of Los Aageiee BUILDI SG
JOHN A LAMBIE COUNTY ENGINEER
® CASSATT D GRIFFIN SUP T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NCROSS s
LEGAL / OWNER
DESCRIPTION LOT NO
BLOCK TRACT a( MAIL
NO OF NOW ON SLOGS LOT TCITY C,� TELflf a J(615SIZE OF LOT
USE OF
BUILDINGS DISTRICT NO GROUT^ NAP
BK P6
CONTRACTOR s
ADDRESS 1Rk v
C
y�ONNECTION DATA
CITY d TEL NO Y�S
STATION 4 /V �/ • (� DEPTH '
�, -- MANHOLE REFERENCE
jj
REGISTRATION NO ' UT TY �7 LOWE
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
Y CURB Q
PUBLIC SEWER @ $3 50 P L M L TOP L
SEPTIC TANKSEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 CO IMP NO JGi.aF@
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNNT
ECT ADDITIONAL BLDG OR STATE ENCROACH
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $100 WASTE APPROVAL
CHARGES
CONNECTION CgARGE FEE
OWNER'S PERM i 1 00
AUTHORIZATION TOTAL FEE ql
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
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THI DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGEN SEPTIC TANK SEEP PIT(S)
ADDRES AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[IAND 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 SYSTEAN
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PITS) ❑ CESSPOOLS[I
OF PERMIT EE
r
JOHN A LAMBIE C90rNTY ENGINEER VALIDATION
7 s IDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
OZ�
- 9AA DEC31 - 4 45 0