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HomeMy Public PortalAbout6336 TRELAWNEY AVE_Sewer__ ::a:ID APPLICATION FOR PERMIT 1 DMSION OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL DsPfnsnt of County Enginom County of Las Angel" euILD(nG JOHN A LAMBIE COUNTY ENGINEER ADDREl9 ® CASSATT 0 GR(FF(N Sup T op ffuiw Ra LOCALITY FOR APPLICANT TO FILL IN ceolslr LEGALOWNER Zea DESCRIPTION LOT NO PAIL BLOCK TRACT ADDRESS SIZE OF LO � �'� SCO NO OF BLDG! CITY TEL NO NOW ON LOT USE oI DISTRICT XO GROUP YAP BU USE O NG9 Pa CONTRACTOR ADDRfilS� CONN.E-YCnON DATA /J STATION 1 Y DEPTH CITY-7 /C NO �O� MANHOLE REFERENCE UPPER 'fTATE REGISTRATION NO COUNTY No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF O W CTION LENGTH FROM PUBLIC SEWER Q 9 S 50 Y RB P L Y L TO P L Z SEPTIC TANK,SEEPAGE PIT OR PITS ANO/OR DRAINFIELD 0 S 9 00 OVERFLOW SEEPAGE PIT DRAINFIELDP C NO EKTN CESSPOOL DRYWELL MANHOLE 0 $E 00 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 0 $I GO TRUNK PERMIT NO ROAD PERMIT NO 3-37 CO NNECT ADDITIONALBLDG OR STATE ENCROACHMENT OUS 4EWER -too PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM 0 $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OM ERAS PmacT S 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE p 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EKISTING DWELLING SEWER 3.30- TO THE PUBLIC SEW R `�/rA L N SIGNED THI DAY F `,r�//-19�LL1%P CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGEN SEPTIC TANK,SEEP, PIT(S) ADORE! AMD/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CCSSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF THE ABOVE DESCRIBED SIGNATURE RESIDENTIAL OPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE (/ SEEP PIT{S) TI CESSPOOLS OF PERMITTEE JOHN A LAMBIE COUNTY ENGINEER VALIDATIROBERT A WOOD CHIEF PLBG INSPECTOR CC M O CAl LJGD 4 4 2 7N MAR 2 3 4 4-50 L`!l