HomeMy Public PortalAbout6336 TRELAWNEY AVE_Sewer_3/23/1956_house sewer connection ::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
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