HomeMy Public PortalAbout5827 TREE ROSE TER_Sewer__ "°" °' APPLICATION FOR PERMIT
79A°41D COUNTY OF LOS ANGELES SEWER—SEWA(WDlSP9pAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION to I WING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN IN JENKINS SUP T OF BUILDING
LocALITY
MUR[rt
FOR APPLICANT TO FILL IN cRo9e BT
LEGAL
DESCRIPTION LOT Mo OWNER
MAIL
BLOCK TRACT ADDRESS
NO OF SLOGS
SIZE OF LOT MOW ON LOT CITY TEL NO
USE OFSU IF DISTRICT NO oROUP MAP PROCESSED BY
USE or
eK ro
CONTRACTO
ADORES CONNECTION DATA
// _ATIon DEPTH �♦
CIT Ll
NO
STAT[ LI / A MANHOL!RLi[RQNC[
LICENSE NO. CLASS (� ` Ali IO
NO DESCRIPTION OF WORK FEE TYPE OP COMN[CTI N LENGTH FROM /
HOUSE SEWER CONNECTING TO Y CURB P ML TOP SQ a
PUBLIC SEWER S°OO C�U
SEPTIC TANK SEEPAD[PIT OR PC nO /l'tI��jj'/ O
PITS ANO/OR DRA INFIELD 0 31000 CO IMP NO PCJ. NO y�J/� 0
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO D[
PRIVATE DISPOSAL SYSTEM 0 3]Oo O
CONNECT ADD ITIOMAL BLDG ORI
AFFIDAVIT *ART• UIINIKT RECORD INSTR NO DATE
WORK TO HOUSE SEWER 0 3300 ty,
OVERFLOW SEEPAGE PIT GRAINFIELD
[%TN CESS POOL DRYWELI MANHOLE 0 SE OO a
ALTER REPAIR OR A°A NOON HOUSENWT OR ST WIDENING Z
SEWER OR DISPOSAL SYSTEM 0 fJ 00STAT[ENCROACHMENT
PERMIT NO
INDUSTRIAL
��T��p Q WAST[APPROVAL
OFTL IXS PEIIMIT CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
1 HAVE AT THIS DATE ACONTRACT WITH THE HEREIN NAM= Co. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE 09SCR1e[D LEI°TING DWELLING APPROVALS TO THE PUBLIC SEWER DAT! INSPECTOR S SIGNATURE
SIGNED THIS DAY OF IB_
OWNER OR NEW HOUSE SEWER I
OWN ERB AGENT_ CONNECT ADDITIONAL
AGGRESS BUILDING OR WORK
SEPTIC TANK SCEP PIT(S)
1 HtRCSY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIONr
RAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AORE[ TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT! LAWS REGULATING
FLU MS ING AND SEWERS L ❑ DRYWELL ❑
1 HERESY CERTIFY "AM R 'STEREO NO/ORPAIR SEWEROR
LI1 91 AS RCOUIRY AND TE OFDISPOSAL SYSTEM
CALIFORNIA OR TH Oi AN T[NO TOECT PLUG AND
RESIDE IN THQ ABAL P HOUSE8IGNATURE SEPTIC TANKSISI ❑ CESSPOOLS
^VALIDATION JACK R ALLEN
cK Y o CASH SUPERVISING MECHANICAL ENGINEER
Lk;o6401kJ SEP 131 0 A 7.00- o