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HomeMy Public PortalAbout6334 TRELAWNEY AVE_Sewer__ APPLICATION FOR PERM TeneASD COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL tl BUILDING AND SAFETY DIVISION FA IpINc WMALAMIM Com(y Ev;�11RBBBT Reee QVol VVQ.LIAM A TEN= SBPfI B.,II 9ALITYREST LiFOR APPLICANT TO FILL IN SS STSLOT X¢ Ile L °LOCK TRACT RESS NO 6F [LOSE Size 01 LOT NOW ON LOT CITY TEL NO USE OF GIST eK PG ;No GROUP MAP PROCESS BY BUILDINGS CONTRACTORwa b g y ADDRESS BTw I CITY TCL STAT[ MANHOLE UPKR REGISTRATION NO COUNTY LOWER NO DESCRIPTION OF WORK F[E TYPE OF CONNECTION LENGTH FROMy HOUSE SEWER CONNECTING TO f� Y CURB P L ML TO P L PUBLIC SEWER Y $500 V SEPTIC TANK SEEPAGE PIT OD JO NO PITS AND/OR DRA INFIELD O LI°OO CO IMP NO 77 OB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT PRIVATE DISPOSAL SYSTEM Y ST 00 CONNECT ADDITIONAL SLOG OR AIFIDAVIT OOTT TUTRCYT RECORD INSTR NO DAT[ WORK TO HOUSE S[WE R • SSOO OVERFLOW SEEPAGE PIT DRAINFI[LD EXTN CESSPOOL ORYWeLL MANHOLE O SSW ALTER REPAIR OR ABANDON OU°[ HWV OR BT WIDENING SEWER OR DISPOSAL SYSTEM Y $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CXARO �T OWNER'S PERMIT s z 00 AUTHORIZATION TOTAL FEE a J CONNECTION CHARGE F 1 HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPRO TO THE PURLIC�SEWQR VALS• D TE INSPECTOR B SI ONA R[ SINNED THIS DAY OF19_ OWNER OR �� NEW HOU E! OWNERS AGENT_ CONNECTOD ITIONAL ADDRESS BUILDING OR WORK SERICTANK SEEP PITISI 1 HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STAT! THAT THE ABOVE IS CORRECT AND AGR LQ TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REOULATIMG PLUMBING AND SEWERS CESSPOOL ❑ DRYW[LL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STAT! OF SEWAGE DISPOSAL SYSTEM CALI FORMIA OR THAT 1M THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND REBID! IN THE AS VE D[BCRIB SIDENTIAL PROPERTY ABANDON NOUS[S¢V/CR S IOMATUR! OF P[RNTTT[E RACKFILL SEPTIC TANKS ❑ BICP 'IT. 6I ❑ CESSPOOLS ATION ROBERT A WOOD �R M o CASH SUPERVISING MECHANICAL ENGINEER L4;o8588% DEC18 8 0 D 21 0.00 • Q IS, � 8589e DEC1810 0 7.00^'