HomeMy Public PortalAbout9232 SPARKLETT ST_Sewer__ M&K4a"II BB APPLICATION FOR PERMIT 1
DTV7SION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dopwimmut of County Englwr
DING 9
County of Los Angdw BUILa _a
JOHN A L.AMBIE COUNTY ENGINEER A0DRE43
m CASSATT D GRIFFIN SUP T DF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS
LEGAL
DESCRIPTION LOT NO OWNER
MAIL ^
BLOCK TRACT ADDRESS K
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OFI
DISTR GROUP YAP
BUILDINGS
�K PG
CONTRALTO �
p
ADDRESS CONNECTION DATA
9
C17T TEL NO 3 3 STATION DEPTH
�jMANHOLE REFERENCE UPPER
REGISTRATION NO Q (p '�. 7 Q COUNTY - LOWER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECYfON LENGTH FROM
PUBLIC SEWER @f 3 SO Y CURB P L Y L TO P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ 3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO JOB No
EKTN CESSPOOL DRYWELL MANHOLE ® f Z 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® S 100 TRUNK PERMIT NO ROAD PERMIT NO
CONWORKETO HOU EI SEWER CT ADD TONAL BLOG OR ® f 100 O �EAYET NOROACNY EXT
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q f 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PmmT s t 00
AUTHORIZATION TOTAL FEE a .00
REIMBURSEMENT FEF
I
HAVE AT THIS DATE A CONTRACT WITH N HAYED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE D ISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DA OF 19— CURLEW ADDITIONAL
OWNER OR `,t.A L�—Pr -1��7
BUILDING OR WORK
OWNERS AGENT_ SEPTIC TANK SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYW ELL❑
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
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THA 1 Y THE LEGAL OWNER OF THE ABOVE
DESCRIBED BESID L PE BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OP PERMITTEE
JOHN A L.AMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK ■ 0 CASK
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