HomeMy Public PortalAbout6400 TRELAWNEY AVE_Sewer__ TaweAsO APPLICATION FOR PERMIT
ReQeeDIIVISION OF B=ING AND SAFETY SEWER-SEWAGE DISPOSAL
Departamant of County Engines
County o/ Los Angela✓, RmLDINa/il00
JOHN A LAMBIE COUNTY ENGINEER ADDRESS W
m CASSATT O GRIFFIN SUP TOF BUILDING LOCALITY
FOH APPLICANT TO FILL IN C"Ro9S
LEGAL OWNER Ce
DESCRIPTION LOT NO
BLOCK TRACT ADDRESS oy �a�/r1 tJ
XO OF BLDG! CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO GROUP YAP
B UILDIN Gb �'
� BN PG
CON 8 op a
ADDRESS C CONNECTION DATA
6TATION DEPTH
CITY /S TEL NO
44 d MA HOLE ER NCE PPE
STATE T-
REGISTRATION NO ❑ COUNTY
No DESCRIPTIO OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION- LENG FROM
PUBLIC SEWER Y CURB P L Y L O P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP HO SOB NO
EKTN CESSPOOL DRYWELL MANHOLE ® !2 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® III DO TRUNK P RMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STAT
WORK TO HOUSE SEWER $1 00 ERYETEN OR T
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWR OR DISPOSAL SYSTU 3 1 DO WASTE APPROVAL
CHARGES
COHNEC CHARGE FEE
OWNER'S PEDIIT s 00
AUTHORIZATION TOTAL FEE �d REIMBURSEMENT FEE
I 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 NEW HOUSE SEWER
SIGNED THISAY OF 19_ CONNECT ADDITIONAL
OWNER OR /t✓/� BUILDING OR WORK
OWNERS AGENT SEPTIC TANK SEEP,PIT(S)
ADDREW AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL Cl DRYWELL❑
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENkIRD AS REQUIRED BY LOS ANGELES COUNTY STATE OF
CALWORN14 OR THAT 1 AM LEGAL WNER OF T ASO ABANDON HOUSE SEWER
D RIBE RESIDENTIAL PROP QEAECPFPLL(SEP❑ CTANKS
ESSP00❑IS❑
bI r
F YI
JOHN A LAMBIE.COUNTY ENGINEER V ATIO ROBERT A WOOD CHIEF PLSG INSPECTOR
C. Lt CD tMR 11 i 0 A 6.00 A