HomeMy Public PortalAbout10151 NADINE ST_Sewer__ 7sAa4aD
Bssallsa APPLICATION FOR PERMIT 1
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DIVISION OF BURDUM AND SAFETY SEWER—SEWAGE DISPOSAL
IUPostment Of Conntp Engineer
CODIILY Of Los Angeles BUILDING /�f / j
JOHN A LAMBIE COUNTY ENGINEER ADDRESS 4
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT =FILL IN CCNEAREST
OSS T
LEGAL OWNER R
DESCRIPTION LOT NO
MAIL
BLOCK TRACT ADDRESS
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOTa= I
USE OF DISTRICT I 6R� I NAP
BUILDINGS BK PG
CONTRACTOR G. P. Constr.
CONNECTION DATA
ADDRESS V1T3Z+ T2ta � ,
p STATIONoe4 DEPTH
CITYDjl rion'te TEL NOG1 . C-9405 MANHOLE EFE ENCE zz
PPER
STATE
REGISTRATION NO 152271 ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF NECTION LENGTH FROM
HOUSE SEWER CONNECTING TO L M L TOP L
PUBLIC SEWER @ S 8 50 CA 7
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO JOB NO
O
EXTN CESSPOOL DRYWELL MANHOLE @ $200
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $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 @ $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERNIiT s 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL 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 ?j'!
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT !n/
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LLAR
S REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
COR THAT 1 THE LEY;N�OF THE ABOVE
DESIDENTIAL OPERTY BACKFILL SEPTIC TANKS❑
SISEEP PIT(S) ❑ CESSPOOLS❑
JOHN A LAMBIE Co TY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK a 0 CASH
V-1597V; xm26 4 4.50 2
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