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HomeMy Public PortalAbout6335 TRELAWNEY AVE_Sewer__ 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 ad, 52 " OR Jm25 4A 4.550 x