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HomeMy Public PortalAbout6403 TRELAWNEY AVE_Sewer__ 566 8 - APPLICATION FOR PERMIT 683 IIVIMON OF SUMMIG AND SAFM SEWER—SEWAGE DISPOSAL Dopm��Bt of CmmtT EBgtM��T CoRDfT of Lob An gslw BUILDING WM J FOX, COUNTY ENGIN-¢R ADDRESS CASBATT D GRIFFIN,SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NROEAREST CS!9T LEGAL A n DESERT TION LOT NO L.4Naff OWNER J�F ! TRAY MAIL ADDRESS J I E OF LOT 10 z ` NOW ON NOCBLOTS CITY • TEL NO Q USE OF BUILDING! DISTRICT NO GROUP YAP SK P6 MOING ug CONTRACTOR VAUEY ADDRESS 8p/M EAST VALLEY BLVD. CONNECTION DATA CITY RDSEMEAD TEL NO AT• STATION Of 3 I GA DEPTH REGISTRATION NO /o0 7A- / ❑ COUNTY �B�/ MANHOLE REFERENCE LOWER TYP NECTION LENGTH FROM NO DESCRIPTION OF WORK FEE Y tune P L M L TO P L HOUSE SEWER CONNECTING TOPUBLI �cz HOUSE EWER ® 7 S SO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 /I�! CONNECT ADDITIONAL BLDG OR CO IMP NO F( 7 JOB NO WORK TO HOUSE SEWER too __ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 100 TRUNK PERMIT NO ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD t 00 INDUSTRIAL CESSPOOL- ORYW ELL -- WASTE APPROVAL SPECUL COGITIONS ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNEWS PmtmT s 1 00 AUTHORIZATION TOTAL FEE ­9770 REIMBURSEMENT FEE I HAVE TRACTORTHIS DATE TO CONNECT THECTED ABOVEWITH THE DESCRIBED HEREINNAMED DWELLING APPROVALS DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER NEW HOUSE SEWER MquL �� SIGNED THIS DAY OF 1SISai . QI OWNEROR I CONNECT ADDITIONAL OWNER! AGENT LA BUILDING OR WORK SEPTICTANK SEEP,PIT(61 ADDRES AND/OR GRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CSSSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE 19 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 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND SPATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT AY THS LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENT PROPERTY BACKFILL SEP C TANKS❑ 13 • SEEP PIT S CESSPOOLS SIGNATURE OF FERMI WILLIAM J.FOX.COUNTY ENGINSYA =A&ATION By -USBI 7 5rm X29 4 450 0 DEPUTY DEPUTY BY BY ® DEPUTY Utr