HomeMy Public PortalAbout9854 VAL ST_Sewer__ 76A6A2D 3J"62. APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION EUILDI NG =
JOHN A. LAMBIE, County Engineer ADDRESS - k ,/
WILLIAM K A, MBIEIf, ount of Building — — ---------
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LOCAL!TY
NE;A RE r
APPLICANT TO FILL IN _Ross 91-
FOR
LEGAL
GE5CRIP77�JN LOT NO. '�' riW NEF
0 MAIL
BLOCK TF7A CT ,. a,,. ar ADDRESS
NO. OF' BLOCS.
5I7.F' OF L:OT yam^.+j:' a'. NOW ON LOT CfTY TEL, NO.
1'E F
BI,ILL I N G S __`: DISTRICT NO. CROUP MAP PROC ESSEis 9Y
-- BK00
PG
CONTRACTOR
- - CONNECTION
ADDRESS DATA✓',..� .+°. :�"�,� �''� ��_---- -- --------
+/ s STAT'I ON Y I DEPTH
C_7Y-o'2. `TEI NO_ a...;r..�' .✓`y'e,.:y>' _-- __-_ _� _ .-. --__— -. - -
.�` r STATE -AN..lE REFERENCE"
REGIS RATION NO. ✓ aF. _:.tee -+�- C`OUNTV � '\LOWER
N6_ Y DESCRIPT!ON Or WORK FEE _ -__ -_-- - _TYPE OF CG"t-c-NON� LENGTH FROM
HOUSE FEWER ER CO-NNECTING 70 ..y{ Y CURB P.L. M.L.TO P.L.
PUHLI St WER C 3S.00
�. -_-._ __--__—
-. _ - L-�.- r c= - P09 NO.
- _ -
Er'Tlt TANK,SEF.PAE p7T OR --'
PITS A`.t D,�OR DRA,NFtELO $10.00 .i 0..IMP NO -1 l N
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H(' SF_Se NEP c_O J 1 hcu .O TRUNK PERMIT NO. ROAD PERMIT NC9
'
PRIVATE DISPOSAL SYS1Em. $3.470
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CONNECT ADDITIONAL BLDG.OR i AFFIDAVIT w.AIVER i EASE.ERi RECOR., Irt:,TR.PJO�- DATE
W RK TO {`7USE SEWER @ $3.00 I
JV'E RPLGW aFE PAGE PtT,DRAIN FIELD
EXTN-.C ESS POOL,OKY WELL.MA dHOLE C�' $5"04
_ iiWY.OR ST.WIDENING z
- 4L7£R_ ABANDON OR ABNDON HJ,s SE .&..
-SEWER OR DISPOSAL SYSTEM @ $9.,00
STATE ENCROACHMENT
PERM',,r NO.
INDUSTRIAL
I. WASTE APPROVAL
HARGES
OWNER'S PERMIT ----- - - ---
AUTHORIZATION TOTAL FEE : CONNECTION eHARr.E EE
IHAVE AT THIS DATE A (.:ONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TA
RCTOR TFX
"..TING CONNECT-THE ABOVE DESCRIBED !STING DWELLING --_..___
TO
T'HE PURL C sr_w'Erx DATE APPROVALS
.. � ;, DA I NSPEOTO R'S SIGNATURE
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SIGNED THIS ::...:�-� .DAY CF'. .,
OWNER O4 # 1 'j: _— ,-. NEW HOO$E SEWER
OWNERS AGENT-
I
yTr
s_ -`, -' - = -- CONNECT ADDITIONA4
UILDING OR WORK
B i
-. --- SEPTIC TANK,SEEP,
5£E .PIT(S) �L
i HFRE.BY ACKNOWL:Eac E. HAT HAVE Pg.-AD THIS APPLICATION ANO/OR GRA!NFIELD
I
A"JD STATE: THAT THE ABOVE- !.5 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY QRDINANCFS AND STATE LAWS REGULATINCG
PL'U M31 Nt� AND SFW FRS. CESSPOOL. I DRYWELL ❑.
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR I
LICENSED AS REQUIRED BY LOS ANGLE'S COUNTV AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIF ORNI:A OR THAT I AM THE. LEGAL OWNER CF, AND INTEND TO --_--
RESIDE Itis, THE ABOVE.--,FSCRi aED. HE DISCONNE._P PLUG AND R
L D..NT'AL PROPERTY'.
�- . ABANDON HOUSE SEWER
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SIGNATURE
OP'' PER MtT ' �( BA Pf'!LL EPTiC7ANKS 10p_
I'
SEEP.PIT(S) ❑ CESSPOOLS T]I
"VALIDAT'ION ROBERT A. WOOD
3`
CK. M.OCASHSUPERV'SING MECHANICAL ENGINEER
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