HomeMy Public PortalAbout5460 SARA MAR LN_Sewer__ TAAG41D APPLICATION FOR PERMIT 1
LBBB 663 12 SA
DISMON OF BUILDING AND SAFETY SEWER—SEWAGE DISPOS L
�(( D.parmL.atof CoaotT EngIYBBP
n__r. of Las AygelyY BUILDING
WM J FOX. COUNTY ENGINEER ADDRESS
CASSATT D GRIMN.SUP T of YUILDIND LOCALITY
FOR APPLICANT TOFILL IN cRoss BY
LEGAL
DESCRIPTION LOT NO LP/O l" OWNERy L l
BLOCK TRACT MAIL AOW
ADDRESS
NOOF SLOGS c
SIZE OF LOT NOW ON LOT CITY I C TEL NO
USE OF `•,
BUILDING! Imo' DISTRICT NO I GROUP YAP I B P6�
CONTRACTOR 3fyf"
ADDRESS CcoM=TION DATA
CITY L NO 9TATIOfl �7/ DEPTH
❑ STATE 0 O MANHOPLLEE ER REFERENCE
REGISTRATION NO ❑ COUNTY
TYPE OF CONNECTION LENGTH FROM
No DESCRIPTION OF WORK FE T •, CURB P L M L To P L
PUBLICSEE�'WE RCON XECTIND TO ® B !60 004 (.P..�o 7v + -r
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM
1 CONNECT ADDITWORK TO HOUSEI SEWER LDG OR 100 CO IMP NO r
O"AL;ALTER ORREPAIR EXISTINGM 100 TRUNK PERMIT NO ROAD PERMIT NO
SEWER OR DISPOSAL SYSTE __
DISCONNECT AND ABANDON !EWER STATE ENCROACHMENT
AND/OR 019PCISAL SYSTEM 1 00 pERYIT NO
SEPTIC TANK,SEEPAGE PIT OR INDUSTRIAL
PITS AND/OR DAAINFIELO 2 00 _. WASTE APPROVAL
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNER'S SMT IF l 00
A�Q�ATION TOTALFEE REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON APPROVALS DATE INSP CTOR S SIONATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER Z
SIGNED THIS- DAY OF 19_
CONNECT ADDITIONAL
OWNER , Opcl BUILDING OR WORK
OWNERS AGENT
SEPTIC TANK BEEP.PITIB)
ADORES AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
TO COMLY
WITH ALL COUNTYH ORDIN NCESABOVE ISC ORRECT AND STATE LAWSANDER CULATPNG OR
PLUMBING AND SEWERS SEWAa6RD SPIOS LESSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES�COODUNNTTYY AND STATE OF ABANDON HOUSE SEWER
DESCRIBED AROR THAT I ESIDENT AL AM THE OPERTY �G yN4fSR-OF THE ABOVE
;; ' BACKFILL SEP C TANKS❑
SEEP PITS CESSPOOL!
SIGNATURE
OF PERMITTEE-
WILLIAM J FOX.COUNTY INKM VALIDATION
LACo1PsYi4rl t�22 4 200 0
BY -- -
DEPUTY DEPUTY
BY BY
DEPUTY _ v DEPUTY
rawuRD S S,4AW 14,V16
S 003 I!!4 APPLICATION FO PERMIT
S i
DrMON OF WING AND SAFETY SEWER-SEWAGE DISPOSAL
DWpmlma1F of Coontf En&Imar
Comof La Angola BO
WDRP3s ��•
M.J FOX. COUNTY ENGINEER
CAREATT D GRIFFIN.WUF T OF EUILDIMW LOCALITY
FOR ANTJO FILL IN NEAREST
CROSS ST A
LEGAL
DESCRIPTION WNER
BLOCK AIL
DDRESS
SIZE OF LOT RS 0 L
9177 TEL NO
use OP
BUILDING! L'
' J DISTRICT NO I GROUP MAP
CONTRACTOR VAJ�r B PO
ADDRESS 141 CONNECTION DATA
CITY EL N STATION DEPTH
10 ❑ STATE EFERENCE
REGISTRATION NO S ❑ COUNTY UPPE
TYPE OF CON CTI LENGTH FROM
No DESCRIPTION OF WORK FEE Y CURB P L Y L TOP L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® S S SO �P7
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO IMP NO NO
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 DO TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
.FITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL•DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY S 00 CHARGES
-- CONNECTION CHARGE FEE
ON"ars PERINUT S 1 00
AUTHORIZATION TOTAL FEE ) /� REIMBURSEMENT FEE
TRACTORNTO CONDATE
ECT THECONTRACTED
ABOVEWITH
DESCRIBED EKISTINGNAMED
DWELLING
APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THI DA LOF 19_ —
OWNER OR CONNECT ADDITIONAL
OWNER A BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP,PITS)
AMD/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIION CESSPOOL❑ DRYWELL❑
D
AND STATE THAT THE ABOVE 15 CORRECT ANAOgE3 TO CO PLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AMD SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE O
CALIFORNIA OR THAT 1 AY THE LEGAL OW ► THE BOV ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY
BACKFILL 9 C NARK!
SEEP
PIT(S)
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION
-BY _L556 4 Q r, J&A. 1,4 4.5 0
�- - - DEFYT7 )d�-
� DEfBT BYTT
J� DEPUTY DEPUTY