HomeMy Public PortalAbout9732 VAL ST_Sewer__ 7moss7mob
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SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COIINTY
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LEGAL / OWNER
DESCRIPTION LOT XO
BLOCK TRACTBAIL
S
MOIRES!
SIZE OF LOT O N WON LOT CITY TEL NO
USE OFILDINGSDISTRICT NO G BAP PRO ESSED BY
BU
/� BR /P6
eT 7
CONTRACTOR �~n —
ADDRESS CONNEMOON DATA
C1TT TEL NO STATION DEPTH
$TATfi MANHOLE REFERENCE UPPER
REGISTRATIOR NO I jr Cl a OUNTT LOWER
No DESCRIPTIOWOF'WORV if FEE
HOUSE SEWER CONNECTING TO /T
PUBLIC SEWER S DO E OF CON CTION LENGTH FROM
SEPTIC T^NK SEEPAGE PIT OR T CU P L M L TO P L
PITS AND/OR DRAINF I E LD 900
OVERFLOW SEEPAGE PIT DRAINFIELD
CE9SP00 DR
TWELL 2 DO
HOUSE SEW ER CONN ECTIN G TO P C NO
PRIVATE M I DO CO IBP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER 2100
ATR R USE QT1 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PmW S 2 00 CONNECTION CHARGE FEE
AUMOMATION I TOTAL PEE -00 REIMBURSEMENT FEE
I HAVE DATE A CONTRACT WITH THE CN-
TM ORA TO CIONNECT THE ABOVE DESCRIBED EXISTIINGAMED DWELLING PROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF I!I_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT BUILDING OR WORK
ADDRESS
SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION /J
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR L,
PLUMBING AND SEWERS F�
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGENECT OSALPLUS SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON
HOU:PLUS AND /
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE ABANDON XOU9E BEW ER
DESCRIBED RESIDEIAL PERTY BACKFILLSE CTANKS
SIGNATURE SEEP PIT B CESSPOOLS
OF PERMITTEE—
®• /�ATION ROB M1M T A WOOD
CL B O CNB SUPERVISING
EC:HANICAL BNOINEER
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