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Home My Public Portal About5459 SARA MAR LN_Sewer__ , 5 9&942 1 APPLICATION FOR PERMIT 1 tDMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Depeubngnt of County EnglMar County of Los Anglia BUILDING �f WM.J FOX, COUNTY ENGINEER ADD11E5 CASSATT D GRIFFIN. OUP T of BUILDING LOCALITY el FOR APPLICANT TO FII...BY , _ cn� A CROSS SST L� �0, •� LEGAL /J rr/r. DESCRIPTION LOLNO/– Q/6 OWNE0. ,„C/_ Gf[ BLOCK TRACT MAIL ADDRESS / Z 6 SIZE OF LOT NON OX LOTS CITY TEL NO USE OF BUILDINGS DISTRICT NO I GROUP YAP SR PC CONTRACTOR ADDRESS CONNECTION DATA L CITYNO . 7 r, STATION DEPTH D { ❑ STATE9.?� f1 MANHOLEUPPER REFERENCE LOVOR REGISTRATION NO "_Z, ❑ COUNTY /Y TYPE OF CONNECTION LENGTH FROM No DESCRIPTION OF WORK FEE Y M• M L TO P L ROUSE SEWER CONNECTING TO PUBLIC SEWER 0) $ 350 v HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR CO ITP NO i� •�� j/ _ WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING 'SEWER OR DISPOSAL SYSTEM 1 00 —_ TRUNK PERMIT NO ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM I DO PERMIT NO SEPTIC TAX K SEEPAGE PIT OR PITS AND/OR GRAINFIELD 2 00 INDUSTRIAL CESSPOOL•DRYWELL -- WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES F) T CONNECTION CHARGE FEE OWNER'SS 1 00 AUTROBTLATION TOTAL FEE Ior, REIMBURSEMENT FEE ITH THE f��n THIS DATE CONNECT THEA ABOVEWDESCR BED EEESTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19— NM HOUSE SEWER OWNER OR I��/it/ CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AMO/OR DRAIMFIELD I 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 1HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OA LICEMBED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT i AY THE LEGAL OWNER OF I ABANDON HOUSE SEWER DESCRIBED pE910ENT1 ROP T BACKFILL BEP C TANKS❑ - SEP RT 8 CESSPOOLS SIGNATURE vi OF PERMITTEE ” WILLIAM J FOX,CouNTY E IP/S[A VALIDATION BY `)L05 4B4 Gtr, ,NL 8 4 4.50 n DEPUTY DEPUTY + _6Y c— ,10 ,'® DEPUTY �� DEPUTY I °BAB,iD APPLICATION FOR PERMIT ssssaDIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1 DopmmbnantoI Coanlp EBylYsar CoantT o! Los Aapalss SDILADORDIE59 NO 5 (' JOHN A LAMBIE COUNTY ENGINEER ✓ m CASSATT D GRIFFIN SUP T OF BUILDIND LOCALITY FOR APPLICANT TO FILL IN RREO SST LEGAL F / • P DESCRIPOWNER 710N LOT NO ACT • AIL ADDRESS SIZE OF LOT NO OF SLOGS CITY TEL NO NOW ON LOT USE OF DISTRICT NO GROUP YAP BUILDINGS BK PG oOoo 724f. CONTRACTOfl AODRE9 �-� CONNECTION DATA STATION DEPTH CITY TEL NO • 6�/ UPPL STATE `MANHOLE REFERENCE - • LOW R REGISTRATION NO COUNTY. - No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM PUBLIC SEWER @ S S SO iYWC P L Y L TOP L SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD , P c N E%TN CESSPOOL ORYWELL MANHOLE S Z 00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM S 1 00 TRUNK PERMIT NO ROAD PERMIT! CONNECT ADDITIONAL BLDG OR STATE EN OACHMENT WORK TO HOUSE SEWER ® S 100 PERU IT NO ALTER REPAIR OR ABANDONHOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM ® S 100 WASTE APPROVAL CHAR CON CTION CHARGE FEE OWNER'S PERMIT s 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN HAYED CON- APPROVALS DATE INSPE TOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THISAY OF 19_ CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGESEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AN 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER ' CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTI ROPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP FETES) ❑ CESSPOOLS❑ ' OF PERMITTEE ' JOHN A LAMBIE COUNTY ENGINEER VALIDATIO)J_ ROBERT A WOOD CHIEF PLBG INSPECTOR LCO6 0 2 9 MAR 14 4 �4.5 0 1"