HomeMy Public PortalAbout10902 WILDFLOWER RD_Sewer__ 3&E-j613 APPLICATION FOR, PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING 10902 >a`�1.�:t�.,f�.t)wer
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS _ y-
CASSATT D. GRIFFIN, SUPT of BUILDING - LOCALITY I. emple 0.1ty
NEAREST
FOR APPLICANT TO FILL IN cRoss ST. 1 and me !
LEGAL ry g OWNER . ss'E 3 �' cons�'T�'u, V
-DESCRIPTION LOT N0. 14J C� p ry
BLOCK_._TRACT 2_..1_049 ryy ADDRESS MAIL ��G� 1� aJr'�`l� Gabriel �(I�E�Ci
NO.OF BLDGS.. G CITY 0t'�...T3.Vl:3cdCi,L'ie-IL. N0. At d '✓.✓
_SIZE OF_L_07 NO_W ON LOT _
l3U31
EOF LDiNGS—z,es .+ �II�i DISTRICT NO, GROUP 4 MAP
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CONTRACTOR 3j.oL-D r 1�„ Construction Co
ADDRESS yl ;. CONNECTION DATA
� 'e" STATION � .. . -DEPTH
CIT EL. 0, "�-^--
a +d l _ -
r'9 MANHOLE REFERENCE
113613 C 42
REGISTRATION N0.
NO_1 DESCRIPTION OF WORK s FEE. _ TYPE OF CONNECTION,,-, LENGTH FROM '
HOUSE SEWER CONNECTING TO Y, lY+ M.L.TO P.L.
---�_PUBLIC SEWER- CURB-- - - $3.50 I0 — -- -
SEPTIC TANK,SEEPAGE PIT OR f T
PITS AND/OR DRAiNFIELD r. $3.00'
OVERFLOW SEEPAGE PI",DRAINFI.ELD -�T_------- P. C. NO, �
EXTN ,_CESSPO.OL,DRYW1LL,NANHO_LE a S 2.00 - CO. IMP. N_O, JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM_ - r) $1:_00_j_�--- _TRUNK PERMIT NO. !ROAD P_£_RMIT NO,
I CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT —
WORK TO HOUSE SEWER !i S 1_.00 I - _PERMIT i30.
ALTER,REPAIR OR ABANDON HC'USEINDUSTRIAL
S
SEWER OR DISPOSAL YSTE6 (ti S I.Q0 WASTE APPROVAL J
---,-�.----- - CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00 ------. — — — -------
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE `4. 130 —
—APPROVALS_ �� DATE ITNsa£CTOR SSIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA},IED CON- - _.-1
TRACTOR, TO CONNECTTHE ABOVE DESCRIBED EXt5TING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS-----DAY OF..-- 1°--- — --- --} —I -- - '------
CONNECT ADDITIONAL
OWNER -ORBUILDING OR WORK _
OWNERS AGENT__.. New E%% .-. ------- -- SEPTIC TANK.SEEP,PITS) I ----_-_--
AvDRE$S_ AND/OP DRAINFIELD l
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL L] DRIWELLLJ E
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
Yul"YH ALL COUNTY ORDINANCE$ AND STATE, LAWS REGULATING: ALTER,REPAIR,SEWER OR '—
f LUMBIN6 AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR .._ -DISCONNECT'PLUG AND
NEC -----I —I-- ---------- - -
LICENSED AS REQUIRED BY LOS ANGELES CO - TY AND STATE OF `
CALIFORNIA OR THAT I AM THE LEGAL 'N R OFTHE ADOV" ABANDON HOUSE SEVER
-DESCRIBES RESIDE N'FL PRO ERY .,, y' BACKFILL SEPTIC TAti RS D
SIGNATURESEEP PIT(S CESSPOOLS tj
----
OF PERMIT.
sof I
JOHN A. LAMBIE, COUNTY ENGINE y�{ LIDAbiOI� ROBERT A. WOOD. C:H:EF F�LBG. INSPECTOR
CK.) N.0. GASH