HomeMy Public PortalAbout6335 TRELAWNEY AVE_Sewer_6/25/1958_sewer connection E Gas ti asAPPLICATION FOR PERMIT 1
•eD ISION OF BUILEIING AND SArM SEWER—SEWAGE DISPOSAL
DePcortwsat of County Enginow
County of Los Angolo* BUILDI N6 ~{
JOHN A LAMBIE COUNTY ENGINEER ADDRESS /
® CASSATTO GRIFFIN SUPTOFBUILDING LOCALITY oo
FOR APPLICANT TO FILL. IN CROSS ST
LEGALOWNER
DESCRIPTION LOT NO
BLOCK TRACT I A DRE39 OWYL+.��
NO OF BLDGS CITY TEL XO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT GROUP YAP
CONTRACTOR
ADDRESS CONNECTION DATA
STATION DEPTH
CITY TEL NO MANHOLE REFERENCE UPPER
O �' STATE LOWER
REGISTRATION NO ❑ COUNTY
1
NO DESCRIPTION WORK FE TYPE
of l'yMl!{MON LENGTH FROM /
HOUSE SEWER CONNECTING TO y UR P L Y L to P L
PUBLIC SEWER @ $S SO
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD ® S S 00
OVERF LOW SEEPAGE PIT DRAINFI ELD P C XO
IXTX CESSPOOL,DRYWELL MANHOLE $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO O
PRIVATE DISPOSAL SYSTEM ® S 1 00 TRUNK PERMIT NO ROAD PERMIT NO
CON NECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 1 00 PERMIT NO
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® S 1 OD WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PEEIdIT s 1 00
AUTHORIZATION TOTAL PEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N YED CON.
APPROVALS DATE INSPECTOR$SIGNATURE
TRACTOR TO CONNECT THE ABOVE DE9 RIBED IX19TING DWELLING
TO THE PUBLIC NEW ROUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER Oe f L12 BUILDING OR WORK
OWNERS AGENT SEPTICTANK SEEP,PIT(S)
ADORES '717 AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE RVADF THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
LICENSED°ASCREOUIREDERTIFY THAT IOSHE MANGELES PROPERLCO AND STATE
RE TERED /OF
DISCONNECT PLUG AND
CALIFORNIA OR THAT TL ER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDEXTI ROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF FERMI TT /
JOHN A LAMBIE NTY ENGINEER VALIDATI ROBERT A WOOD, CHIEF PLEIG INSPECTOR
�KUQI
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