HomeMy Public PortalAbout10200 NADINE ST_Sewer__ 70AS420
opOrrro APPLICATION FORPERMIT
coum OF LOS Amun SEWER SEWAGE DISPOSAL 1
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OF SIZE OF LOT �/To x NOW ON QTS OI I pAA t%/ TEL NO Q/- 10 TZ
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CITT T E 61rTEL NO IS/- y&944.?.Z STATIOR •jLa DEPTH
STATEMANHOLE BEF O
REGISTRATION NO COUNTY .r
467
No DESCRIPTION OF WOK FEE
NOW SEWER CONNECTING TO
UBL C SEWER 8 OO TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR T CURB P L M L TOP L
PITS AND/OR DRAINFI LD 800
OVERFLOW SFsEPAGE PIT DRAINFIELD
EXTN CESSrPooOuI DRTWE'LL MANHOLE !00
HOUSE SEWER CONNECTING TO / P C No
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP n0 JOB NO
CONNEC ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
pW�OTREKgT HOUSE SEWER 1 00
SEWER OR DISPOSRALBSYSTEM HOUSE 100 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNmls PEW= IF 1 2100 CONNECTION CHARGE FEB
AuTHORMIL1701191 TOTAL FES REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAVED CON APPSOYATS DATE INSPECTOR 8 SiBnATUR6
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS^AY OFI g_ NEW HOUSE SEWER —)
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRE� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CESSPOOL 13 DRTWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HERERT CERTIFY THAT I AN PROPERLY REGISTERED AND/OR STATE OF DISCONNECT PLUG AND
CALIFORNILICENSED ASOR TNATE 1 AN THE LEGAL OWNER OLOS ANGELES COUNTY FN7716 ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY _ BACKFILL BE C TANKS❑ /y
8IGMATUR6
/•C//IJOW PITS CESSPOOLS 131
OF PE
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