HomeMy Public PortalAbout10130 NADINE ST_Sewer__ *9A64APPLICATION FOR PERMIT
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s a6a fi eB
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Dep bnent of County Enghum
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS Oe'
® CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
NEAREST
FOR APPLICANT TO F111 IN CROSS ST
LEGAL OWNER
DESCRIPTION LOT NO i
BLOCK TRACT MAIL ADDRESS Lfle
NO OF BLDGS CI TEL
SIZE OF LOT NOW ON LOT
USE
BUILDINGS BK DISTRICT NO GROUP I MAP
T P6
CONTRACTOR
ADDRESS CONNECTION DATA
CITY � /,LS�4 TEL NO S+ STATION EF INCE DEPTH
_ MANHOLE REFERENCE PPER
REGISTRATION NO 2L ?C ❑ COUNTY
'
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM 42 7
HOUSE SEWER CONNECTING TO �� Y CURB P L M LEN
TOP L
PUBLIC SEWER Q ;9 50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $300
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE ® $2 00 CO IMP NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $100 PERMIT NO
ALTER REPAIR OR ABANDON
SEWER OR DISPOSAL SYSTEM HOUSE ® $100 INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT s Do
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATUR
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THI DAY 19 CONNECT ADDITIONAL
OWNER ORhgL
BUILDING OR WORK
OWNERS AGEN SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLdbGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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
1 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 O4ENM
THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESRTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTE
JOHN A LAMENGINEER ^VALIDATION ROBERT AWOOD CHIEF PLBG INSPECTOR
( (,.3 7 $c7IR DEC 31 4 4 5 0 0