HomeMy Public PortalAbout10912 WILDFLOWER RD_Sewer__ 7eA64ZO
.66311-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING 1091
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
2 Wildflower Rd.
CASSATT D.GRIFFIN, SUPT OF BUILOtNO LOCALITY City
NEAREST
FOR APPLICANT TO FILL IN CROSS ST, WPI I �jrp.
o:we r 1_?0d ]o_n__C
_tru:
AL
LEGAL
-DESCRIPTION LOT NO. OWNER J. B. b e r Oonztruciloii�
FOR
TRACT .MDDRESS
B
A
At
0
NO.OF BLDGS. bar, Gabri el-T51.. NO. At /--05_3751
SIZE OF LOT NOW ON LOT CITY
USE OF
_UDLNG__S DISTRICT NO, GROUP MAP
Aezd�e� BK PG
CONTRACTOR
L. D_ L_ constri"n'tinn C30
ADDRESS 21 1 . Wistaria �ive. CONNECTION DATA
7l - 77
STATION t
N DEPTH
CITY Arcadia TEL. NO. Hj 6-2238 MANHOLE REFERENCE
REGISTRATION NO, 113613 C 4STATE2
No DESCRIPTION OF WORK FEE
T 10 N,,P�A
HOUSE SEWER CONNECTING TO TYPE OF CONNECT LENGTH FROM
Y. CURB M�L. TO P.L.
PUBLIC SEWER @ $3,50 ,
P"I
TANK,SEEPAGE PIT OR
PITS A`N'D/OR DRAI $
I�LID 0
OVERFLOW SEEPAGE PIT, DFtAINFIELD P C. NO.
EXTN.,CESSPOOL,DRYW ELL.MANHOLE (k $2.00 CO. IMP, NO. _JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE.DISPOSAL SYSTEM TRUNK PERMIT-NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.ORSTATE ENCROACHMENT WORK TO HOUSE SEWER 1.00
PERMITNO.
1 ALTER,REPAIR OR ABAND014 HOUSE INDUSTRIAL
�SFWER OR DISPOSAL SYSTEM WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 5 REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
IHAVE AT Till$ DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE 1INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLINC
TO THE PUBLIC SEWER_ NEW HOUSE SEWER
SIGNED THIS-----DAY OF _.—___t9__._
CONNECT ADDITIONAL
OWNER OR 7 BUILDING OR WORK
OWNERS AGENT — SEPTIC TANKSEEP PITiS)
ADDRESS-__ ND/OR DRAI,N FI F_L'D_
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
-- ,
A
AND CESSPOOLO DRYWELL�
STATE THAT
T HE ABOVE IS CCRRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWER$, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND'I
CF,
LICENSED As REQUIRED BY LOS ANGELES COUNTY AND STATE DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL 0 OF T ABANDON HOUSE SEWER
HE ABOVE
DESCRIBED RESIDENTIPROPERTY. BACKFILL SEPTIC TANKS Ll
SIGNATURE SEEP. PIT(S) [I CESSPOOLS!j
OF PERMITTF
IOHN A. LAMBIE,COUNTY ENGINEER ALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
C x L N.O. CASH
4