HomeMy Public PortalAbout6361 TRELAWNEY AVE_Sewer__ ::(;,II Bp APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportnsnt of Co maty Englnwf
County of Los Angel" R
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JOHN A LAMBIE COUNTY ENGINEER S
m CASBATT D GRIFFIN SUF TOF BUILDING TY
FOR APPLICANT TO FELL IN ST �irv.�vr.
LEGAL
DESCRIPTION LOT NO
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BLOCK TRACT K b S
NO OF BLDGS TEL NO
712E OF LOT I6� NOW ON LOT
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BUILbIN09CONTRACTORL: PO
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ADDRESS CONNECTION DATA
6?�o N 4— IO. c/ DEPTH
kAAkLjQTEL XO LE REFERENCE PPr] STATE � A r L
REGISTlAT10N NO ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF ION LENGTH FROM
PUBLIC SEWER @ f 3 SO Y pB P L M L TOP L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® f 3 00
OVERFLOW SEEPPOOL ORYW DRAINFIELDEXTN CO IMP NO J0, 77 JOB NO
OVER CESSPOOL GE PIT DRAINFIELD
® $2 00
ROUSE SEWER COX NESTING TO
PRIVATE DISPOSAL SYSTEM ® III DO TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER f 1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® S 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S FERM T s 1 00 C aQ1
AUTHORIZATION TOTAL FEEjj4 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED
EXISTING DWELLING
TO THE PUBLIC SEWER �t- NEW HOUSE SEWER
SIGNED THISL:DAY OF �K L ' 19J Q CONNECT ADDITIONAL
OWNER OR C BUILDING OR WORK
OWNERS AGENT �T '
-� SEPTIC TANK SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 1 AY PROPERLY REGISTERED AND/OR AND
DISCONNECT PLUG
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HO PLUGUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
BEEP PIT(S) ❑ CESSPOOLS
OF PERMITTEE ,
JOHN A LAMBIE. COUNTY ENGINEER VALIDATIO ROBERT A WOOD CHIEF PI-BG INSPECTOR
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