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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