HomeMy Public PortalAbout5508 SARA MAR LN_Sewer__ r
•Na Gas It as APPLICATION FOR PERMIT 1
76"420 APPLICATION
OF BURDING AND SAFETY SEWER-SEWAGE DISPOSALDepacirtineat of
County of �Angel"i � BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO IN 5ROSS ST
LEGAL OWRER
DESCRIPTION LOT NO /
AIL
BLOCK TRACT ) �' —ADDRESS y
NO OF BLOGS CITY TEL NO
SIZE OF LOT NOW-ON'LO'''J..
BUILDIN09Wza �vw DISTRICT NO GROUP YAP
BR — f6 ;
CONTRACTOR 1/C7_
CONNECTION DATA
ADDRESS /
1 STATION DEPTH
CITY TEL NO f, MANHOLE REFERENCE UPPER
ATE LOWER
REGISTRATION NO 0 COUNTY
No DESCRIPTION OF WORIC FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LEN OTX FROM
PUBLIC SEWER $S SO Y CURB P L M L TOP L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR GRAINFIELD ® S S 00
OVERFLOW SEEPAGE PIT DRAINFIELD Pc
NO
EKTN CESSPOOL DRYWELL MANHOLE ® $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® S 1 00 TRUNK PERMIT NO ROAD PERMIT NO ,
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PEHbUT i 1 00
AUTHORIZATION I TOTAL TEE I
REIMBURSEMENT FEE
AAE) CON.I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN APPBOVALS DATE INSPE ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER , NEW HOUSE SEWER
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLO DRYWELLO
ANO 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
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LEGAL OW HER OF THE ABOVE
DESCRIBED
RESIDEN A OPERTY ECPFiL SEPTIC ATANKS
SIGNATURE BEPIT(S) ❑
OF PERMITTEE
JOHN A LAMBIE COUNTY ENGINEER AM TION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK MIO GIN
19 Jm 4 4 A 450 2