HomeMy Public PortalAbout10158 NADINE ST_Sewer__ D
9aa6APPLICATION FOR PERMIT 1
8$s 663 11
OF MUDDIG AND SA= SEWER—SEWAGE DISPOSAL
Depwftent of Canatp Engineer
County of Los Angeles BUILDING / i is
JOHN A LAMBIE COUNTY ENGINEER ADDRESS L ✓
® CASSATT D GRIFFIN SUP T oFBuaDINo LOCALITY
LEGAL FOR APPIMA//N��T�� TO FIQLL IN CROSS ST
DESCRIPTION LOT NO N. /TV orm 6 '""To eOWNER
r PAIL
BLOCK TRACT E. S�, Q� �/ ADDRESS f
NO OF
SIZE OF L s2 `p NOW ON LOTS CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP I YAP
BK P6
CONTRACTOR
ADDRESS `( CONNECTION DATA
1t ` O / O
y � STATION �� DEPTH �O�"~
C /t,l(/ TEL NO MANHOLE REFERENCE Q r
/ ❑ 'f �s G LOWER
REGISTRATION NO COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM .L
HOUSE SEWER CONNECTING TO Y CURB L ML TO P L .Tr
PUBLIC SEWER Q $S 50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $S 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO / $ ]OB N o
EXTN CESSPOOL DRYWELL MANHOLE @ $200
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® $t 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $1 00 PERMIT NO
ALTER REPAIR ORA ANDON
Bj
SEWER OR DISPOSAL SYSTEM HOUSE 1 00 INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERSpERiwIIT s t 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECT O SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER f NEW HOUSE SEWER a12 0,
SIGNED THIS DAY OF a2 19"� CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT '�� SEPTICTpNK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
IHEREBY 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
LDESCRIBED
AND SEWERS SEWAGE DISPOSAL SYSTEM
HE
CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
A OR THAT I AM THE 11L OWNER OF THE ABOVE
RESIDEN PRO RTY�l SEEP FILLPIT(S)P❑ CESSPOOLS❑
TTEE / r �/ ����-
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PL60 INSPECTOR
CK Y C CASH
7253A .M21 4 450
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