HomeMy Public PortalAbout5478 SARA MAR LN_Sewer__ '.9b K 6D 3 It 34 APPLICATION FOR PERMIT
S` �'��'S`�"►,�oNE],
eBKKKDVISION OF B IIIc AND SAM SEWER—SEWAGE DISPOSAL
D*I, e d of County EeglneB2
COnnty of Los Angeles BUILDING
WM J FOX. COUNTY ENGINERR ADORES!
CASBATT 10 GRIFFIN,SYP'T OI BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
LEGAL1*0
DESCRIPTION DINNER
0 MAIL
ADORES �A Fet�X�
o v
SIZE OF LOT A O CI TEL NO
USE OF
BUILDING! P DISTRICT NOV OOUUP BK YAP ►0
CONTRACTOR Jo
ADDRESS I CONNECTION DATA
CITY, V STATION /�/ 7t-LIZ, J DEPTH t'
❑ STATE MANHOLEREFERE
REGISTRATION NO ❑ COUNTY UPPER LOWER
TYPE OF CONNECTION LENGTH OY
NO DESCRIPTION OF WO N FEE Y CURB P L Y L TOP L
HOUSE SEWER CONNECTING TO Y 6 •/•�i A
PUBLIC SEWER ® $ S$O .7 _
HOUSE SEWER CONNECTING TO I
PRIVATE DISPOSAL SYSTEM 1 00 _
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER 1 00 NOJOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON!EWER STATE ENCROACNY
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK,SEEPAGE PIT OR
PITS AMD/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL•DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 S
_ CONNECTION CHARS
OWI'IE$'B PERMIT S 1 00
AUTHORIZATION I TOTAL FEE Q REIMBU9NT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDCON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THI DAY OF 19CONCT`
OWNER OR BUILDING OROITIONWORKLL
OWNERS AGER
ADORES SEPTIC TANK,eEEP, P17(!)
AND/OR DRAIXFIELO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP CATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE T COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW! REGULATING
PLUMBING AND SEWERS ALTER, REPAIR SEWER OR ,
SEWAGE DISPO!(AL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCOHOUSE SEWER
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACK►ILL SEPMC TANKS❑
/ SEEP ►R S CT3SPOOL/
SIGNATURE
OF PERMITTEE
WILLIAM J.FOIL,CouNTY ENomEan VALEDATIQN
-BY - - _& , 4 9� JUL 14 4.5 0 ID
DEPUTY /
_ ' ! Ory_41 DEPUTY
BY BY �
® DEPUTY DEPUTY