HomeMy Public PortalAbout8628 ROCCUS LN_Sewer__ E808-10-63 '
6A64ZO APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
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6EPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FN
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JOHN A. LAri'IB%E, County Engineer � _ �{'� ✓ � �..-^ ,._x � �-=___._--
WILLIAM A. JENSEN, Sup'! of Building i_ I
LO--A[-!TY t
FOR APPLICANT TO FILL INST
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LEt AL
DESCRIF ION LOT NO i .- - _. OWNER
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MAIL
ADDJJ
BLOCK TRACT r > r� y ~. TYREss re
-- - NO OF BLO O"S.
SIZE OF LOT NOW ON LT J L. NO. d
USG OF
BUILDiNGS DISTRiCT NO. GROUP ASAP PROCESSED BY
PG
BK
_
�77
CONTRACTOR.
ADDRESS ,, CONNECTION DATA
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STATION "� h � DEPTHi .
CiTY / �.iL NO. ..K
UPPFR
MANHOLE REFERENCE
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REGIST<ATIN NO a ../ [, COUNTY'
NO -r GES C.R i PlTi ON OF WORK FEr TYRE OF CCNNEC IOPJ
. $5.00- .fab-_iEF:N3.G
H FROM
H'U SEWER CONNECTING TO Y CURB PL M.L.70 P L.
F BL tSEWER
0-
P.C.
-P C NO 0
Co. IMP NO.
PITS ANC'OR DRAIN cLD g10.00
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D SE SCW ERC:O N N E__.T It:GTO.._____. .__..--..r
F r?IVDT€:D SP JSA.L ST S FM j -RUNK PERMIT NO. ROAM?PERMIT NO.
$-3.00
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CC'N NI';T AD}I71OPiAl BLDG.OR AFF'ILAV17 %'A!V R E0.SF.MfsaT �R€'C ORO.INSTR Np- � DATE y�
WORK OHO SE SEM ER 53.00
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OlERe LOW SEEPAGE 7,DRAINFi LD
HWY.OR ST.W;DENING. _
i Ik'OR ®ANDON HOV3a.E 1 1
ddb
j SEWER OR DISPOSAL YSTE'M
' _}_______.- - STATE ENCROACHMENT
i I PERMIT NO.
--- ----�------ NDUSTRI.AL
WASTE APPROVAL
.------. --CH—AR—G-E—S
PERMIT �OWNER'S 2i oo
CONNECTION.CHARGE FEE
AUTHORIZATION 7 "-,, I C,
--�------------.
'IHAVE AT TH!S DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR 70 CONNECT 'TtiE ABOVE DESCRIBED EX!STING DWELLING ---- 7� ------ ----- -- -'--
TO THE Pj Bp SEWER.' ,: AI'l"RO YAL� I DATE �INSPECTOR'S SIGNATURE
SIGNED THIS -tom DAY OF 'S e_ .—_t8/'� _—. .--- ------- — — --- - -
OWNER OR J/J .>✓ NEW.HOUSE EWER
OWN€RS AGENT _,y L-�Y' L—___
_
CONNECT ADDITIONAL
ADQRES -" BUILDING OR WORK
_. „- --`� SEPTIC TANK SEEP.,PIT(S) I
1 HEREBY ACKNOWLEDGE THAT . HAVE READ THIS APPLICATION AND/OR DRAINFIELO j
AND SATE 'e 4iA, Tli E' ABOVE15 COR'k ECT AND AGREE TO COMPLY
WIT}! ALL COUNTY ORDINANCES AND STATE: LAWS REGULATING
P L.UMB1NG AND SEW FR.S. CESSPOOL ❑ DR YW ELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
ASE SE2DNIA OR 73i RT AM _S STATE OF SEWAGE DISPOSAL SYSTEM
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LICENSED AS REQUIRED BY lOS ANGLES OUI^I"'Y AND
E.- k.GAi-,0WNFR OF AND INTEND TO
D1`u 'ONNEC. PLUG AND
RE„I Dc- IN, THE 1B.nVE ES PiE D AESIOLN IAL. PLOP RTY.
w:� ND N HOUSE SEWER
SIGNATURE .�_% ✓:' .-. - rr _ —_ _—_... _— —_—L—_—__ _._ __—�..____
A
,Y�+'y r _ J y �,;,_.:- BACKFILL SEPTIC TANKS
OF PERMITi'EE _ _ _ -- — - SEEP.PIT(S'} CC,SSPOOLS
-VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.D. CASH
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