HomeMy Public PortalAbout5516 SARA MAR LN_Sewer__ *aE Ga,11MB APPLICATION FOR PERMIT 1
DIVISION OF BUf ING AND SAFETY SEWER-SEWAGE DISPOSAL
D"mrWmnt of Conatp F.ogina
(.'09n1T Of f•0E AngMbsaX BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CABBATTD GRIFFIN HUPTOFSUIL IHQ LOCALITY P-7 F 401
LEGAL
FOR CANT TO IN OWNER CROSS ST
DESCRIPTIO L N
BLOCK � TRACT
NO OF BLDGS TEL No
SIZE OF LOT NOW OX LOT
USE OF
BUILDIM69 DISTRICT NO GROUP YAP
A� BK PB
CONTRACTOR
ADDRE94 CONNECTION DATA
EL NO �Q / STATION 2 I-.29 f DEPTH
OeAftMANHOLE REFERENCE UPPI!TER
491 STATE
REGISTRATION NO ❑ COUNTY
NO DESCRIPTICTN OF WORK FEE
HOUSE SEWER CONNECTING TO T CURB L L TYPE OF CDNXECTIOP LEN OTHTOP FROM
Y
PUBLIC SEWER S 3 50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3_L0_
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CUSPOOL,DRYWELL,YANHOLE® $2 00 CO IMP NO 10B NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® S 100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® St 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE - -
OWNEB'S PERMT s 1 00
AUTHORIZATION TOTAL FEF REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE IN PE -0 SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER _ NEW HOUSE SEWER
SIGNED THIS SAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADORE— AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL CJ 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
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AMD/OP AND
D14CONNECTPLUG
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSEAND
EWER
CALIFORNIA OR THAT AY THE GAL OWNER THE ABOVE
DESCRIBED REST RT ROPE BEEP FILLPIT SE❑ CESSPOOLS I❑LS❑
SIGNATURE
OF PERU[TTE
JOHN A LAMBIE.CcMNTY ENGINEER \/A],IDATION�� ROBERT A WOOD,CHIEF PLBG INSPECTOR
u K 0 uFx •
(moi o 34t, AUG 6 4 45 0 0