HomeMy Public PortalAbout5836 TREE ROSE TER_Sewer__ CE°O°' °' APPLICATION FOR PERMIT 11
TeAiAso COUNTY OF LOS ANGELES SEWER—SEWAG"ISPOS&Lu
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONJA
ILDING
JOHN A LAMBIE COUNTY ENGINEEROR[u
COLEMAN W JENKINS SUPT OF BUILDING
LOCALITY
FO& APPLICANT TO FILL INLEGAL
LOTMOIL
BLOCK TRACT ORE"OI BLDG%
SIZE OF LOT MOW ON L T Y SIL NO
USE Oi TRICT NO GROUR MAP PROCEeno BY
SK OF a• eK CONTRACTORAOGREERATION DEPTH 1(2CITU 6L MO T°TA C NHOLE REFERENCE L MBPlt
ICENfI NOi CLASS NO DES R N OF WO K FEE TYPE OF CONNECTION LENGT FROM �j �/MOUS[SEWER CONNECTING TO CURBML TOPL Z{/PU BLIC E[W[R 49 E°00iCPTICTANK {![PADS PIT 011 PC MOPITS ANO/OR ORA INFILD Y slow IMP NO JOB NO ��KOUB9{EWER CONNECTING TO UNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM 0 fI OO O
CONNECT ADDITIONAL BI. OR FIDAVIT MN• ILtIRIRT R[CORO IN°TR NO DAT[
WORK TO HOUS[i[WCR C ff GOOVERFLOW{[[PAGE PIT GRAINFIELD
[ATN CESSPOOL ORYWELL MA NHOLZ O EB GO ALTER R[PAIROR ABA NOG"HOU Y ORST WID["IMO y[W[R OR DISPOSAL SY/TEM C fDGOATt ENCROACHMCNTRMIT NO
INDUSTRIAL
ic�
WAITS APP110VAL
O�t/�T ER•S PERM T f Y DD CHARGES
ALrMORMATION TOTAL FEE CONNECTION CHANGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE H[R[IN NAMED CON REIMBURSEMENT F[[
TRACTOR TO COMMC(CT THE ABOVE DESCRIBED {RIpTIMG I"
ER
OWLLLG APPAOVALS
TO THE PUBLIC SEWDATE IMSP[CTORBSIONATUR[
SIGNED THIS DAY OF IB_
OWNER OR NEW HOUSE{EWER .�
OW NLRB AGENT_ CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
69RIC TANK BEEP PITIS)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ "IS APPLICATION AMD/OR GRAINFIELD
AND /TATE THAT THE ABOVE li CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAW/ REGULATING
FLUN°IMO AND $EWERS CESSPOOL ❑ DRVWLLL ❑
1 N[RLpY CERTIFY THAT 1 PROPER SO
AND/OR ALTER REPAIR SMRROR
LIC[Np[O Ap R[OVIRCD AN C NT MO ST
X. 01 $[WAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I Y [6 OW q ANO 1 NO TO DIicONM[CT PLUG AND
RCD1D! IM THE ABOV Ip R[ll PROP ApAMDO"HOUSE
iIONATURC ❑
OF
PCRMfIT!° BACKIILL SEPTIC TANK/
i[[P PITS/) ❑ CESSPOOL.
0VAMATION JACK R ALLEN
M G CASH SUPERVISING MECHANICAL ENGINEER
Li"6404:d X131 0 A 7,00- Q
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