HomeMy Public PortalAbout10916 WILDFLOWER RD_Sewer__ ED
3& 663 ii-SS APPLICATION. FOR PERMIT 1
3&E•Fi
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN!A. LAMBiE, COUNTY ENGINEER ADDRESS __—"il d f #1T TCa t° ]�d
CASSATT D, GRI
FFIN, SUPT OF BUILDING LOCALITY '-OempleFOR APPLICANT TO FILL IN CROSS T 5ellarld A C.LEGALs-ci',DESCRIPTION LOT N0. 1 OWNER J. B. Jeber Cons U�' .BLOCK TRACr 23949 MAILADDRESSNO.OF BLDGS. CtTYSan �° `�-�y T£L. NO< At f""'
SIZE OF LOT — NOW ON LOT
USE OF _--Bu — DISTRICT NO. I GROUP BK MAP PC
-BUILDINGS .r�SC21�:110E: f
CONTRACTOR L. D. lY., L1. V Ons
v� t{ _ CONNECTION DATA-
21
ATA
ADDRESS L.�_-B .eyU._�lUs—a�""�.,a Ave •�} pp � � -----------Arcadia TEL.N0. Aj- 6.223LJ STATION S { DEPTH
CITY -- -- ------- MANHOLE REFERENCE l UPPER
J STATE
REGISTRATION N0, _ _j _3_- C 42__ --
NG DESCRIPTION OF WORK FEE -_--- --- — - --- - -- --
---- ---- — y TYPE OF CONNECTID LENGTH FROM y
j HOUSE SEWER CGNNECTING LO !! Y. CURB p M.L.TO P.L. i
PUBLIC SEWER. @ S s.SD j }e 0 : -- -- -----�,k -----
._. ----T ---- -- -- ------ - - .-_r
SEPTIC TANK,SEEPAGE PITOR -
PITS AND/OR DRAINFIELD (i $3.00
- --- --PA - - --- $ 00
OVERFLOW SEEPAGE PIT,DRAINFIELD �I P. C. N0.
c TN..;CESSPGOL,DRYIVE'I,L,IIANHO.LE (ri 1 CO, IMP. N0, 10H NO
---� HOUSE SEWER CONNECTING-TO---- - --__.r ------- -- --
_ PRIVATE DISPOSAL SYSTEM (i _$1._000 i TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
I WORK TO HOUSE SEWER , $1.00 PERMIT NO,
ALTER,REPAIR OR ABANDON HOUSE i INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM ��, $1.00 WASTE APPROVAL
CHARGES,
. ----- .__.------------------- -...0000____..__�. —..-------'---------
CONNECTION CHARGE FEE
OWNER'S PERMIT $ i 11 00 --------- ------ —_�.---- — -
--------- I E;;.---- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE � 41.-56 1� Tp
APPROVALS DATE INSPECTORS SIGNATURE
t HAVE AT 7H1a DATE.A CONTRACT WITH THE HEREIN NAMED CON- -_--- _---_-- ----,_-—.---� _-- _ _-- ------------
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEL'd HOUSE SEWER
SIGNED THIS— DAY OF T9_..—. CONNECT ADDITIONAL
OWNER OR 6UILDINU CR WORK
EPSEEP,
_ --- _--� ---.--— -_.---
OWNERS AGENT . ---_ -----�_.-_ SEPTIC TANK,SE P PIT(S)
ADDRESS--__ AND/OR DRAINFIELD
--_ -- .-- ---'-- -- .0000._-- ----- ---
I HERESY A KNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLD DRYWELLC-J i
AND _,ATE THAI THE ABOVE IS CORRECT AND. AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR �
PLUYBING AND SE'W'ERS, _SEWAGE DISPOSAL SYSTEM
i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND --------_--
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND SKATE OF I
N60N HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGA NER OF THE ABOVE ABA ! 1
DESCRIBED RESIDENTIAL PROP,�,R '- ry BACKFILL SEPTIC TANKS
SIGNATURE ESSPOOLS� _ --
OF PERMITTE 6•uz f �----- -----
I
IOHN A. LAMBIE, COUNTY ENGINVR VALIDATION ROBERT A.WOOD, CHIEF PLBG. INs rCTOR
c3M. 0GASH