HomeMy Public PortalAbout6350 TRELAWNEY AVE_Sewer__ TEMPLE CITU �?aAvmltl
Moog*so APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPASTmENT OF COUNTY ENGDYEES
BUILDING AND SAFETY DIVISION ADDRESS p
BILDI9 16 !7 NV
OTTY A. LAD®T6 =t
Tf D 6MIFFIN. 81811 e!DwldleQ LOCALITY It/ l�
F
OR APPLICANT TO
CROSS BY /✓ �Y✓.ter
AL
PTION LOT NO OWNER -07-
BLOCK TRACT MAIL /
It v MTRAC
ADDRESS
NO OF BLDGS
LOT NOW ON LOT 1 In Do
O DISTRICT NO GROUP YAP PROC BY
CTOR �O({ B6 PG
. Co. O
S -OfeG� �//�' CONNECTION ASA
TEL NO d -��j�Y STATIONDEPTH
ST
ATE MANHOLE REFERENCE PPHR
ATION NO L COUNTY LOWER
1I) R PT10N0 OR FEE
UBLIC DEWS RCONNECTING TO f9 00
SEPTICTAXKSEEPAeE PITOR TYPE OF CONNECTION LENGTH FROM
PITS AMO/OR ORAINFIELD S T CURB P L Y L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD
EZTN C R $200
HOUSE SEWER CONNECTING T° P C NO
PRIVATE AA TT N1ITLL EM 100 CO IMP NO JOB NO
WORK TO XOUBEISEMERBLDG OR 1 !J-0 TRUNK PERMIT NO ROAD PERMIT NO L
ALTER REPAI01)
R OR AB NOON HOUSE ITATE ENCROACHMENT
OR DISPOSASEW31 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEHLS PERMT 2 00 CONNECTION CHARGE FEE
AUMOHTLATION TOTAL F� REIMBURSEMENT FEE
I HAVE AT THIS TRACTOR TO CONNECT THCo
E ABOVE DESCRIBED QISTA CONTRACT WITH THE NN6ADWEL INMED E APPROVALS DATE INSPECTOR 991GNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGEMT BUILDING OR WORK
ADORERS SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STAT[ THAT THE ABOVE IS CORRECT AXD AGREE TO COMPLY CESSPOOL DRTIVELL rl
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS
1 XEREBT CERTIFY THAT I AN PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REOU IRED BT LOS ANGELES COUNTY AND STAT[ OF DISCONNECT PLUG AND
CALIFORNIA OR THAT AY THE LEGAL 0 NEB OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED REBIOENTI PR BACKFILL 9E TANKS
SIGNATURE SEEP PIT 9 IC CESSPOOLD
OF PERNI
�VALIDATIO /_ - ROBERT A WOOD
/� a. ■ 0. CL.B 811PBTTVIYING MBCUiANICULL MNOINMIQt
�l
C05 3 0 5 AUG 2 2 1 0 D 3 .00
►�-- _ J
s a[Abas II 05 APPLICATION FOR PERMIT 1
DIVISION OF BUWING AND SAFETY SEWER—SEWAGE DISPOSAL
D"mt n*W of ComtT Englmw
CoTmtf of f,OM Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASSATT O GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN caoss eT
LEGAL
DESCRIPTION LOT NO OWNER J
MAIL
BLOCK TRACT ADDRESS
NO OF BLDGS CITY TEL NO
SIZE OF LOT D NOW ON LOT Z T7-31-766
USE OF 1DISTRICT NO P YAP
CONTRBUILDACTOR
F... BK G�
CONTRACTOR Ohl
ADDRESS CONNECTION DATA
W.2 zz
CITY TEL NO STATION DEPTH
MANHOLE REFERENCE f'' U PE
Cq STATE o1 O I" L R
REGISTRATIO 0 LI COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO O TYPE OF UR TION LENGTH FROM �P
PUBLIC SEWER @ $3 SO Y P L Y L TO P L lJ
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® 3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C XO
EZTN CESSPOOL DRYWELL MANHOLE ® $Z 00 CO IMP NO lOI NNO
-PRIVATE
DI OSAL SYSTEM HOUSE SEW"CONNECTING
TO ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO 6 I 1 1
CON N ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OK DISPOSAL SYSTEM ® 100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT s 1 00
AUTHORIZATION TOTAL FEF REIMS UR$EY ENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR$SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EKISTING DWELLING
TO THEPUBLIC SEW R NEWHOUSE SEWER
SIGNED THI DAY OF 19 s5 [oMNEci ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS A E SEPTICTANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICA ION CESSPOOL❑ 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 PLUGAND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON NOUSESEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI ROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
BEEP PIT(S)(] CESSP00
OFF PERMITTEE
PERMITTEE /
JOHN A LAMBIE C06iTY ENGINEER VALIDATION\ ROBERT A WOOD,CHIEF PLBG INSPECTOR
L CD2 4 5 9 A NOV 19 M 4 UH 4.5 0 o