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HomeMy Public PortalAbout8604 ROCCUS LN_Sewer__ A64i, APPLICATION FOR PERMIT 6 A 6�;2.l:1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION EUILDFNG JOHN A„ LANIBIE, Supt of Building County Engineer VVADDREss -- _ >WILLIAMA. JENSEAF, g � LOCALiTY N EA RF 5T FOR APPLICANT TO FILL IN ROSS T f Y �.E GAL ESCRII'i ION L.OT'NO l OWNER �,;: 7 MAIL ) y r BLO::K TRACT .� .�' ACDP,t55 /",�, _✓__ _.J_ J �� ,..�.v.__ _ � _. .. NO. OF SLOGS'. _ a is s SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF -BUILDINGS - fa D�ST'2!C NO :;RCU1' MAP PFiOCE55CD BY CONTRACTOR r A.DDRE s ONNE_C_TION DATA --- — T � STATION / �f 7 '(, DEPTH "t CST i� �- TEL NO:�:-..�_.�F `'--'Jfi'AYE MANFf,ALF.'.REFERENCE '� y ` ' J gap REG.STRATION NO.. COUNl'Y - - LOWER NO. I` DESCRIPTION OF WORK FEe------ ---- ---..r_.,._-----LEN6TH FR _ _ '7SYPE OF CONNECTION LENGTH FRRt -:{HOUSE SEWER CONNECTING TOY. CURB P L MTO P,1-1;1' PUBLIC SEWER @-$5.00 SEPTIC TANK,5EEPAGE PIT GR___ "`--1 NO. P:TS.AND/OR DRAINFIELD $10.00 I CO. IMP.,NO. -. JOB NO. h10 U5.E SEWER CION NEC7 NG TO TRUNK PERMIT NO- ROAD PERMIT NO. PR VATS DI F QS.AI SYSTEM. � $B.00 CONNECT A 1`TIONAL BLDG OR --f AFFIDA.ViT wk1Y£A FAS£ME N7 RECORD. IN5TR.NO DATE �1 ._ WORK"O E OJSE SEWER @ 33.©x_ _— --_ T, ' OVERFLOW� OW 6=EPAC@ PIT,DRAINFIELD EXT N..CE SSPOOI..,DRYWELL,MANHOLE @ $5,00 <--- -__. _._-- HWY� QRST.W;DCNINto' 3 0. TDR.Rs•PAiP OR ABANDON HOUSE SEWER OR Df FOSAL�YSTF_M 53.00 ! -BL4TE ENCRCACNMEtr?�- -� ."_-- - --` -�-` -----� ' .._.—. PERMITNO. I_----�_---. INJUSTft AL WASTE APPROVAL CWA RGES OWNER'S PERMIT z, oo ------ -- —_ . CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE—---- ___---_— z — — '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED f_ON. REIMBURSEMENT FEE 3 TRACTOR TO CONNECT I'}i F_ ABOVE: DESCRIBED EXISTING DWELLING --- -- wL"�-r'� {O THE PII BI_L S W,.r3. '-I _ APPROVALS. DATE / INSPE'CTOR'S SIGNATURE SIGNED THIS - ,.DAY OF '7--�'-- _-9�-----F9 --'-- ---- '----- - - - I ---�--'- - OWNER OR )`�" - NEW HOUSE SEWER OWNERS AGENT CONNEC:7 ADDITIONAL_.__—�:��_,�.—_� BUILDING OR WORK I I ADDRESS.— SEPTIC ` =1�----•-L: --._--_-_-� SEPTIC.TANK,,SEEP,Fk7`$y—_— i HER BY ACKNOWLEDGE 'T THAT i HAVE READ THIS APPLICATION ANO,/OR DRAINFIELD AND TATE 1!'Ar Y�r ABOVE 15 CORRECT AND AGRFF TO COMPLY -- 'WITH ALL COUNTY NTY ORDINANCFS AND STATE LAWS REGULATING' n� PLUM$ hG AND SE4YE RS. CESSPOOL [� ORYWELL t� HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR L'CFN5EO AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM � ,-.Al,.iFORNI.A OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RCSID£ IN. THE ABOVE DESLR;8ED RESIDENTI -'R,ftYy�'+ERTYr - ABANDON HOUSE SIGNATURE AKr.L .EPTIC TANK° OF PERMITTEE SEEP, y CESSPOOLS �I --_-- —_-------' VALIDATION ROBERT A. WOOD SUPERVISING -MECHANICAL ENGINEER M.O. CASH