HomeMy Public PortalAbout10906 WILDFLOWER RD_Sewer__ r6AG4215 17-55 - APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles F--
NEAREST
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JOHN A, LAMBIE, COUNTY ENGINEER _ � �s� f����(i`i � _��Y�J�?(> ��(��
CASSATT D. t RIFFIN, SUPT OF'BUILDING - iOa�'"'), l€,-', CiyFOR APPLICANT TO FILL IIT T, vv'e 1.1 and g _
LEGAL -- - - - e - 8`'i•C�3C .' Const
� �.IC �,Off. y
DESCRIPTION LOT NO. ley OWNER B.
MAIL
BLOCK --TRACT0, 0
- San
Blvd.
ADDRESS
NO.OF BLDGSCITY Qan GabriOLTEL. NO.At ?-0531
SIFLOT NOW ON LOT--2--
USE
USE
OF .DISTRICT NO. GROUP [ MAP
_BUILDINGS_ i- BK PG
CONTRACTOR
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CONNECTION DATA
ADDRESS 21 aV. -aria *Ave.ve -
-`- p'I- STATION Ll DEPTH
CITY Arcadia _-TEL. NO. Ili �n?G _ �-�-�--- -- �_ -
- - -1 �^-y ��vv MANHOLE REFERENCE -
REGISTRATION NO,. 1136 .3 V ` 2 � STATE
No. i DESCRIPTIO OF WORK FEE — - ---
�IL�USESE+hER L'ONNE 1'IN6.TO---- --- - -- TYPE OF CONNECTIO.- � LENGTH FROM
d^i -Y- CURB P.L. M,L.TO P.
PUBLIC SEWER _ @--_$3.50!_ 3 . `.,d ---.._...._ ------
1 SEPTIC TANK SEEPAGE PIT OR j
PITS AND/OR DRAINFIELD - Ca` ;$.3.00 --. ..--- - -- ----- ---
OVERFLOW SEEPAGE PIT, DRAINFIELD j P, C. NO.
i
i_ERIN.,CESSPOOL.DRYWELL,MANF..OLE rci $2.00{ CO. IMP. N0. JOB N0. ✓ -
A HOUSE SEWER CONNECTING TO I
PRIVATE DISPOSAL SYSTEM (it $1.00 I TRUNK PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR ! STATE ENCROACHMENT
WORK TO HOUSE SEWERP, 01 $1..00 � PERMIT NO,
'-ALTERREPAIR OABANDON HOUSE i. ..._ -_I. ----_----- ---~
SEWER-'OR DISPOSAL SYSTEM <a_S I.DJ l INDUSTRIAL
--_ - .-- -�..---__-_-- WASTE APPROVAL
_-..:�---------- CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT -- -- --- - - —--
�-- S 00 REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAi4I! C N- APPROVALS ll.4TE IINSPECfUR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EX'S"PING DWELLING -
10 THE PUBLIC S£+w E.R. NEW HOUSE SEWER I
I.
SIGNED THIS.._ _DAY OF 19-_._ _._ _
CONNECT ADDITIONAL
OWNER OR —BUILDINGOR WORK_-,
.OWNERS Af;ENT - -_—wr SEPTIC TANK SEEP,PIT($) I -
ADDRE AND/OR DRAINFIELD —_
IH
ACKNOWLEDGE T NAT I HAVE READ THIS APPLICATION CESSPOOL❑. DRYV ELL O I
AND STATE THAT THE ABOVE IS CCRRECI AND AGREE TO COMPLY
WITH ALL COJNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM -
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR E-1 - .- ---'----- �-! ---
LICENSED ASSPrliJIRED BY LOS ANGELES COUNTY AND S1-ATE OF DISCONNECT PLUG W
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
Ej
DESCRIBED RESID-NTI L PROPER.-Y. " '' BACKFILL SEPTIC TANKS Ej
SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE .� - ---- - ---- ---- --OF PERMITTEE
I
JOHN A. LAMBIE, COUNTY ENGINEE , VALIDATION ROBERT A. WOOD, CHIEF PLEIG. INSPECTOR
CASH -