HomeMy Public PortalAbout6410-6412 TRELAWNEY AVE_Sewer__ a&9 sit Be APPLICATION FOR PERMIT 0 '112- 1
DIVMON OF BIIIMMG AND SMM SEWER—SEWAGE DISPOS L
D"xwbw t of Co" EnginMK
CO=ty of Los An9sioR BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
m CASGATTD GRIFFIN SUPTOFBUILDING LOCALITY
FOR APPLICANT TO FILL IN u05"ST
LEGAL OWNER
DESCRIPTION LOT NO
RAIL ' `
BLOCK TRACT 0, '] p ADDRESS„( �L-/ z !!]
NO OF BLD69CITY T
SIZE OF LOT NOW ON LOT SM+
USE OF DISTRICT NO GROUP YAP
BUILDINGS I /� CSK PG
CONTRACTOR ti 4 1 )C �3
ADDRESS L CONNECTION DATA
fTATION140 DEPTH (10
CITY �'On TEL NO G MANHOLE REFERENCE UP
0 STATE
REGISTRATION NO
(p / / ❑ COUNTY ' A WER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CORB ON LENGTH FROM
f• PUBLIC SEWER @ $3 SO31
(� Y CURS P L Y L TOP L
SEPTIC TAN KSEEPAGE PIT OR
PITS AND/OR DRAINFIELD0 S3 00
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
EKTN CESSPOOL DRYWELL MANHOLE ® S E 00 CO IVP No I JOB NO
HOUSE SEWER CONNECTING TO J 3
PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD PERMIT N
CONN ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORN TO HOUSE SEWER ® S 1 00 6 V PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'3 PEEi�T s 1 DDS
AUTHORIZATION TOTAL FEE ft) 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 AEW HOUSE SEWER
SIGNED THIS DAY OF 19— CONNECT ADDITIONAL
OWNER OR Q BUILDING OR WORK
OWNERS A6Fk1. SEPTIC TANK SEEP,PIT ISJ
ADDRESS ANO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM `
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR OISCORNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I A HE LEGAL ER OF THE ABOVE
DESCRIBED RESIDENTIAL P ERTY BACKFILL SEPTIC TA NKS❑ -TO
SIGNATURE SEEP PIT(S)❑ CESSPOOLS m
OF PERYI
we
JOHN A LAMBIE, COCA ENGINEER ALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK ■ o CASH
29515 APR15 4 A 550 n