HomeMy Public PortalAbout5837 TREE ROSE TER_Sewer__ CEp0p3 ea APPLICATION FOR PERMIT
TBAEAan COUNTY OF LOS ANGELES SEWER—SEWADISP SAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu1Lo1Na
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUPT OF BUILDING
LOC•LIT
NEAREST
FOR APPLICANT TO FILL IN RDE. °T la 4fe
LEGAL
DESCRIPTION LOT NO OWNEAll
R
O MAIL
BLOCK TRAtt O ADDRESS
N OF LDGS
SIZE OF LOT W ON LOT CITY TEL NO
U[[ OF DISTRICT NO GROUT MAP PROCESSED BY
BUILDINGS
IK
PO
CONTRACTO �, \
AGGRee CONNECTION DASA
CITY [L NO
STATION 1,f,08DEPTH l
STAT[ OL
LICCNSQ MO C MANHOLE REFERENCE
LASpQ �EFCR�
NO DESCRIPTION OF WORK FEE TYPE OF
CONNECTION LCNOTH IRON
MOUSE SEWER CONNECTING TO Y CURS L.ENO TO P l /
PUBLIC SEWER 0 ES OO
SEPTIC TANK B[[PAG[PIT M JOBPCNONO O
PITBAND�OR DR AIRFIELD SI000 CO IMP NO G V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO OC
PRIVATE DISPOSAL SYSTEM Y 5300 O
CONNICTADO ITIONAL SLOG OR AFFIDAVIT IMTT• "1101 T RECORD INS" NO DATE
WORKTO H OUSE SEWER O 33 GO U
OVERFLOW SEEPAGE PIT DRAIMFICLD a
EIITN CESSPOOL DRYW[LL MAN H OL[O Se GO HWy OR ST WIDENING Z
ALTER R PAIR O ABANDON HOU.!
B EWER OR DISPOEAL SYSTEM O 5300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNWS PERMIT f 00
AUM01 LATION TOTAL FEE 2 CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FE!
TRACTOR TO CONN QCT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
O`.w*O
•ALS
TO THE PUBLIC SEWER DATE IXSPECTORSBIGNATUR!
SIGNED THIS DAY OF 19_
OWNER OR NEW HODS[S!W!R
OWNERS AGENT_ CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
EPTIC TANK SEEP PIT(9)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOM SAND/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AOfl[E TO COMPLY
WITH ALL COUNTY ORD INANCCS AND STAT[ LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYW[LL ❑
1 HERESY CERTIFY TH M PROP LY ISTIRED ANO/OR ALTER REPAIR SEWER OR
LICENSED A. R..U'RE BY A TY AN STATE OF SWAGE DISPOSAL SYSTEM
CALIFORNIA OR THATAL OF • INTEND TO DISCONNECT PLUG AND
R[SID[ IM THE AB R D XTIAL P RTY ABANDON HOUSE SEWER
SIGNATURE [3OF PERMTTTE SACK FILL SEPTIC TANKS
SEEP
'ITIS) ❑ CESSPOOLS
OVALIDATION JACK R ALLEN
cK M D CASH SUPERVISING MECHANICAL ENGINEER
�6 3 9 9SEP 13 1 O A 7.00-
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