HomeMy Public PortalAbout6334 TRELAWNEY AVE_Sewer_12/18/1962_house sewer connection APPLICATION FOR PERM
TeneASD COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL tl
BUILDING AND SAFETY DIVISION FA
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VVQ.LIAM A TEN= SBPfI B.,II 9ALITYREST LiFOR APPLICANT TO FILL IN SS STSLOT X¢ Ile
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°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
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