HomeMy Public PortalAbout10137 NADINE ST_Sewer__ 70
sa9esa66llae APPLICATION FOR PERMIT 1
DMSION OF BUMDMG AND SAFETY SEWER—SEWAGE DISPOSAL
DepurhneW of Cauaiy Engineer
City of Loa Aagelee BUILDING •
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT =FILL IN CROSS gST
LEGAL OWNER
DESCRIPTION LOT NO
MAIL /
BLOCK TRACTADDRESS
NO Ot BLDGS I CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO I GR I B MAP PG
BUILDINGS 7&460
CONTRACTOR G P Con--tr.
ADDRESS 225 IV Bryant Rd. CONNECTION DATA
CITY E1 TIonte TEL NO Gx• 6-9405 STATION O DEPTH
1 e� MANHOLE REFERE CE
REGISTRATION NO 152f'71 ❑ COUNTY
NO DESCRIPTION OF WORK FEE [ypE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO ro- P::
L M L TO P L
PUBLIC SEWER @ S 8 50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 0 $S 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE ® $200 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 0 S 100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER S 1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ sloo WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PMMT a 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ' J�
TO THE PUBLIC SEWER NEW HOUSE SEWER (/
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OOWNER WNERS AGENT JQ ) BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESU AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 M THE LEGAL 0 ER OF THE ABOVE
DESCRIBED RESIDENTIA ROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PITS) ❑ CESSPOOLS❑
OF PERMITT
JOHN A LAMBIE C TY ENGINEER �(ALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK M ousx
01 5 g 6fl Aug 26 4 450 2