HomeMy Public PortalAbout6342 TRELAWNEY AVE_Sewer_12/14/1955_house sewer connection 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