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HomeMy Public PortalAbout6342 TRELAWNEY AVE_Sewer__ 76AS420•&[eeAPPLICATIOI�FOR PERMIT 1 DIM$ ION OF BUMDING AND SAFETY SEWER—SEWAGE DISPOSAL DBpozbuBnl of County FagfB�/T -T County of Los An9e1�B 0UILDI lG 4 WM J FOX COUNTY ENGINMKR CASSATT O GRIFFIN,SUP T OF BUILDING LOCALITYI :Tim'llleQ FOR APPLICANT TO FILL IN NEAREST v n CROSS ST LEGAL DESCRIPTI N LOT I OWNER BIOGK TRACT b� !P 3 MAIL 2 AGGRESS rr MO OF BLDCS SIZE OF LO NOW ON LOT CITY le, TEL NO USE OF BUILDINGS DISTRICT NCr GROUP _ YAP CONTRACTOR Jr BK q PG J ADDRESS f' CONNECTION DATA CITY TEL NO STATION DEPTH ❑ STATE `0 MANHOLE REFERENCE REGISTRATION NO Q ❑ COUNTY ✓ UPPER TYPE OF CONNECTION LENGTH FROM 9� NO DESCRIPTION OF WORK FEE CURB Y L TO P L HOUSE SEWER CONNECTING TO 0 PUBLIC SEWER ® S 330 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 DO CON N ECT ADDITIONAL BLDG OR CO IMP NO77 JOB NO WORK TO HOUSE SEWER 100 ALTER OR REPAIR EXISTING rj rO SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO .f�..7 DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 100 PERMIT NO SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL•DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNERS PE9>,2I1' S 7 00 AUTHORIZATION TOTAL FEE f� REIMBURSEMENT FEE 1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER /_ , SIGNED THI DAY OF �'" �"'� 191 I NEW HOUSE SEWER _A OWNER OR CONNECT ADDITIONAL OWNERS AG BUILDING OR WORK SEPTIC TANK SEEP PITS) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE T 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRTWELL❑ 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 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DEBCRIBED RESIDENTIAL PROPERTY BACKFILL CE96POOL9 SIGNATURE OF PERMITTEE WILLIAM J FOX,COUNTY ENGINEER VALIDATION ,.L&O &5 48; OEC14 4 4.50 a BY BY _ DEPUTY DEPUTY '(b BY / m DEPUTY DEPUTY