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HomeMy Public PortalAbout5833 TREE ROSE TER_Sewer__ C"O°' °' APPLICATION FOR PERMIT TSASAED COUNTY OF LOS ANGELES SEWER—SEWAgrE DISP SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILD JOHN A LAMBIE COUNTY ENGINEER ACC"••• COLEMAN W JENKINS SUPT OF BUILDING Locwurr N[ARUT LEGAL FOR APPLICANT TO FILL IN `.a •T DESCRIPTION LOT NO -:37 OWNER MAIL BLOCK TRACT ADORES{ o OF SLOGS SIZE OF Lorzl� Now ON LOT CITY TEL NO Ust OF DISTRICT NO GROUP MAP PROCESSED by BUILD NOs SR PD CONTRACT r r ADD"ue CONNECTION DATA RATION DEPTH CI [L MO STAT[ LIC /' //i— MANHOLE REFERENCE OWER LICEN at Mo, 4wf1 ` 7 NO DESCR I N O WORK P[[ TVP[01 CONN[RION l KOTII Fmom HOUSE SEW{R CONNECTING TO �y,T Y CURS P M L TO P L a PU°LICE[WER O Eeoo (/V PC MO E[rtIC TANK SEEPAGE PIT OR co IMF No Joe No O O Pm AND/OR GRAINFIELD O sl000 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROM FEAR IT NO �. PRIVATE DISPOSAL SYSTEM 0 ss 00 O CONNECT ADDITIONAL SLDO OR AFFIDAVIT POr[[ lY[R[RT RECORD IMSTR NO DAT[ WORK TO XOU S[S[W[R 0 Q 00 !y' OVERFLOW SEEPAGE PIT GRAINFIELD [ETN CESSPOOL DRYWELL MANHOLE 0 Sam ALTER PA ROR ABANDONHOUSEHWY OR 6T WIDENING N SEWER OR DISPOSAL SYSTEM 0 ss 00 STAT[ENCROACHMENT PERMIT NO INDUSTRIAL WARt APPROVAL ����p CHARGES OTT1Tr.a s PMMT • z o0 AUTHORIZATION TOTAL FEF CONNECTION CHARGE FEE 1 HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED COM "[IMSURSEMENTI[{ TRACTOR TO CONN CT TNS ABOVE D[SCRI°[D L[ISTIMO DWELLING APPROVAL) TO THE PUBLIC SEWER DAT[ INSPECTOR[SIGNATURE SIGNED THIS DAY OF 18_ OWNER OR NEW HOUSE S[W[R OW Mt RS AO[N_ CONNECT ADDITIONAL NILDINO OR WORK ADDRESS SEPTIC TANK 8[[P PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STAT[ THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING PLU MSINO AND S[W[M CESSPOOL ❑ DRYWELL ❑ 1 HEREBY Ct RT1FY THAT I AM PR LY [°IST INTIM AND/ORI ALTER REPAIR SLW[ROR LICENSED AS R[OUIR[D LEE NTY A BTATE or S[WAO[DISPOSAL SYSTEM CALIIp11NIA OR TMAT T AL R OF INTEND TO GISCOMMLCT PLUG AND R[SIG[ IM TX[ A "TIAL P[RTY ABANDON HOUSE SEWER HONATUR[ BACKFILL SEPTIC TANKS ❑ or PERMM' S[EP PITISI ❑ CESSPOOLS OVALIDj{IgON JACK R ALLHN cK M o CASH SUPERVISING MECHANICAL ENGINEER LAL,o6 4 O O�z X13 1 0 A 7.00- V zaw