HomeMy Public PortalAbout6426 TRELAWNEY AVE_Sewer__ as ie:It as - APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL 1
DevazlBaent of Comity &ttl1nw
CGMnfp of Los Angelo. BUILDINGa 6
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASSATTD GRIFFIN RUITOIBUILDING LOCALITY
FOR PLIC O IN cRO4M
LEGAL
DESCRIPTION LO?Ng:?
BLOCK TRACT QV ADDRESS I
NO OF BLDGS CITY TEL NO
S12E OF LOT NOW ON LOT 6_i .L.�
USE OF
BUILDING! Vla DISTRICT NO GROUP YAP
/ K PO
CONTRACTOR
ADDRESS 1 CONNECTION DATA '
CITY ^CN TEL NO p STATION DEPTH
MANHOLE REFERENCE UPPER
43—rATE
REGISTRATION NO
❑ COUNTY
NO DESCRIPTIONO WORKHOUSE SEWER FEE TYpE OF
CTION LENGTH
FBOY
PUBLIC SEWERCOXNECTING TO @ S SID S Y R P L Y L TO P L 9
SEPTIC TANK SEEPAGE PIT OR
PITS AMD/OR DRAINFIELD $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO SOB NNO
EATN ,CESSPOOL DYWELL,MANHOLE ® $2 00
PRIVATE DISPOSAL SYSTEM HOUSE SEWER CONNECTING
TO ® S 100 TRUNK PERMIT NO ROAD PERMIT NO M-2 Q37
CONNECT ADDITIONAL BLDG ON STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $1
00 PERMIT NO
ALTER REPAIR OR ABANDONHOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM S 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
LADDRESS-
MMIS PED= S 1 00 REIMBURSEMENT FEE
THORIZATION TOTAL Fee
VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
HE PUBLIC SEWER NEW HOUSE SEWER
ED THI OF 19_ CONNECT ADDITIONAL
ER OR BUILDING OR WORK
ERS AOLNT� 9EPTICTANK,SEEP,PIT(S)
ES AND/OR DRAINFIELD
EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONCEggpOOL❑ DRYWELL❑
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ALL COUNTY ORDINANCES AND STATE MWS REGULATING ALTER,REPAIR SEWER OR
BING AND SEWERS SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
NSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFABANDON HOUSE SEWEa
FORNIA OR THAT 1 AN XE LEGAL NLR OF THE ABOVERIBED RESIDENTIAL RTY OEEPFILL PIT SEP❑ CTANKS OLS❑
ATURE PERMI
JOHN A LAMBIE C ENGINEER VALIDATION ROBERT A WOOD,CHIEF PLBG INSPECTOR
CK M 0 u5M
LAC06 4 3 2fn KAR26 4 4.5 0 In