HomeMy Public PortalAbout6439 TRELAWNEY AVE_Sewer__ GARD
as saaas APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
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WM J. FOX.COUNTY ENGIN— ADDRESS"
CAYYATT`D..ORIFnI.IN,,GU y or SYRm�N*O LOCAFOR REPLICANT TO FILL. IN NEARCROSLE6ALD69CAIFTION LOT RO OWNE
BLOCK TRACT ADDRESS MAIL
NO OF SLUGS
SIZE OF LOT 1, NOW ON LOT CITY Np
USE OF
ILDINGS DISTRICT NO GROUP YAP
CONTRACTOR 10- v� i BK PG
ADDRESS 1317 GOLEGROVE AM q CONNE=ON DATA
CITY EL NO STATION 3 F d DEPTH
❑ STATE MANHOLE REFERENC UPPER
REGISTRATION NO 148659 (STATE) ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE NECTION LENGTH FROtl O
HOUSE SEWER CONNECTING TO y URB F L Y L TOP L
PUBLIC SEWER 3 SO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR F C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING '
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT N
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT ON
PITS AND/OR GRAINFIELD 2 00 INDUSTFkAL
CESSPOOL ORYW ELL WASTE A ROVAL
4FECIAL CONDITIONS ONLT 2 00 CHARGES
OWNER'S p�MIT $ 1 00 CONNECTION ARGE FEE
AUTHORIZATION TOTAL FEE S REIMBURSEMENT E
TRACTORHAVE CONNECT THE AABOVECTED WDESCRIBEDITH THE
EXISTING HEREIN A DWELLING APPROV DATE INSPECTOR SSIGNATURE
TO THE PUBLIC S E /
SIGNED THI DAY 19 NEW HOUSE SEWER G
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
lEPTIC TANKGRAINFIESEEP PITIS)
ADDRESS AND/OR LD
1 HEREBY ACKNOWLED E 'r'HAf 1 NAVE READ THIS APPLICAT N CEg4P00L❑ DRYIN ❑
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO CO LY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR ER OR
PLUMBING HEREBY
AND SEWERS SEWAGE DISP LSYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OF DISCONNEC PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THA 1 A LEGAL OWNER OF HE ABOVE ABANDON OUSE SEWER
DESCRIBED RES AL P PER BACKIF SEP C TANK!❑
SEEP IT 3 CESSPOOL!
BIONATURE
OF PERMI
WILLIAM J.FOX,Cou"VFNQt�o VALIDATION R A WOOD.CNIMF FLoo INMFMCTOR
!;�1 35 SP OM30 4 450 �