HomeMy Public PortalAbout6453 TRELAWNEY AVE_Sewer__ Sa 9+63II-BB APPLICATION FOR PERMIT 1
DIVISION OF BUWING AND SAFE-N SEWER—SEWAGE DISPOSAL
Dopwt=nt of Comfy Engtnoor
Canty of Los Angel" BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS s
m CASSATTD GRIFFIN SUPTOPSUILDING LOCALITY
F APPLICANT TO FILL. IN SS SST
LEGAL OWNER
DESCRIPTION LOT NO
Z O MAIL
BLOCK TRACT AODRE33 �Q j
lza OFBLDGSCITT L,// TEL NO
SIZE OF LOT WON LOT
USE OF DISTRICT I CT 0 GROUP I YAP
BUILDIX 63
BK P6
CONTRACTOR � d/-1
ADDRESS 3 / S �' of CONNECTION DATA
CITY TEL NO STATION DEPTH
MANHOLE REFERENCE UPPER
❑ STATE L i
REGISTRATION NO D ❑ COUXTY
NO DESCRIPTION OF WORK EE
HOUSH eEW EiI CONNECTING TO TYPE OF C CTION LENGTH FROM
PUB C SEWER @ S S BD Y B P L M L TOP L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD pi,
C MO
EKTN CESSPOOL DRYWELL MANHOLE ® S 2 00 CO IVP NO p,B NO
HOUSE SEWER CONNECTING TO Q 'J
PRIVATE DISPOSAL SYSTEM ® $1 GQ TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $110 PERMIT NO
ALTER REPAIR OR ABANDONHOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERbUT s 1 DD (�
AUTHORIZATION TOTAL FEE 616
[ALTER,
EIM RSEMENT FEE &v.4A �y
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 SEW �ryNEW HOUSE SEWER
SIGNED THIS DAY OFA'(� y 1942NNECT ADDITIONAL
OWNER OR �� ILDING OR WORK
OWNERS AGENT PTIC TANK,SEEP PIT(S)
ADORE! D/OR DRAINFIELD
I HEREBY AC NOWLEDGE THAT I HAVE E THIS APPLICATIONSSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 19 CORRECT AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING REPAIR SEWER OR
PLUMBING ANDSEWERSWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORNNEGT PLUG ANDLICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFANDON HOUSES ANDCALIWER
FORNIA OR T T i AY THE LEGA O OF THE ABOVEDESCRIBED RES' IAL PROPERTYOyy�iCKFILL SEPTIC TANKS❑
SIGNATURE EP PIT(S) ❑ CESSP00
C PFAYI
JOHN A LAMBIE,CouNTY ENGINEER VALIDATIO ROBERT A WOOD CHIEF PLBG INSPECTOR
OX M 0GrN
(�3 9 2 9 JO 7 4 550 ID