HomeMy Public PortalAbout10922 WILDFLOWER RD_Sewer__ E.65$
&E•663 if-55 APPLICATION FOR PERMIT 1
'i&E -
DIVISION OF BUILDING AND SAFE'd'Y SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING ry�y Wildflower
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JOHN A. LAMBIE, COUNTY ENGINEER -ADDRESS -10922 F ildflower d,.,
CASSATT D. GRIFFIN, SUF'T OF BUILDING - LOCALITY `'_
FOR APPLICANT TO FILL IN cRoss s 1,eliand Ave.
LEGAL
DESCRIPTION LOT N0, 12 — _ OWNER J.E - jVP CT. /QOq y� ,-1-°jTct i v')n rQQn
9�I MAIL �7 3 17^{} r°
.BLOCK TRACT , •9 ADDRESS 272 Y2 Gabriel Blvd.
SIZE OF LOT NOWOONBLOTS 2 CITY �;,yLa.n G .briejTEL, N0. At
USE OF — _ DISTRICT NO. GROUP MAP
_BUILDINGS _ Residence BK PG
CONTRACTOR T
ADDRESS ' 3
•� Wistaria`z � CONNECTION DATA
- lrx —._T.
''+2 STATION :. DEPTH -
clTr A�"C�.t3�,a� TEL.�Io, Hi 6� s'�.j� UPPER:.
---- ry r MANHOLE REFERENCE
_ - L C�� ❑ STATE --- —_ ---
REGISTRATION N0. 361 42 Y
NO, j DESCRIPTION OF WORK FEE ------------- --'--- ----
HOUSE SEWER CONNECTING TOTYPEOF-CONNECTION LENGTH FROM
@ $3.50
--� PUBLIC SEWER - _-- - Y .— CURB P.L-�. M.L.TO P.L.
� - -'
SEPTIC TANK,SEEPAGE PIT OR -�
PITS AND/OR DRAINFIELD $3.G0
OVERFLOWEEPAGF P[T,D.RAINFIELD --^--- - P C. NO,
I LX N,,CESSPOOL,DRYWELL,MAN.HOIL Q $9_.00 --i CO..IMP. N0, JOB NO.
HOUSE SEWER CONNECTING TO ---- — '--I_. ---- --- ------ --- ��---_._._-
PRIVATE DISPOSAL SYSTEM (o' $1,00 �. TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG. OR STATE ENCROACHMENT
WORK 10 HOUSE SEWER (q: $1.00 _ I - PERMIT NO.
ALTER,REPAIR.OR ABANDON HOUSE - I INDUSTRIAL
_j SE1'!ER OR DISPOSAL SYSTEM fa. $1.00 iWASTE APPROVAL
( - CHARGES
--- _--_--- ____-` _-_-- CONNECTION CHARGE FEE
OWNER'S PERMIt1 00
--- ----- - --- -----
I
AUTHORIZATION TTAL FEE � �1 5® REIMaURSEMENT FEE
O
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS I DATE 11NSPEC"fOR'SSIGNAT LIRE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING [)WELLING
TO 'CHE PGB LIC SEWER. NEW HOUSE SEWER
SIGNED THIS_ _DAY OF - _19 CONNECT ADDITIONAL I --_-
OWNER OR
A� BUILDING OR WORK I
- _--
OWNERS AGENT._._ 1�0 �--------
-- SEPTIC TANK,SEEP,PIT(S'.
ADDRESS- AND/OR DRA.INFIL-LD
1 HERE BY ACKNOWLEDGE THAT 1 HAVE. READ THIS APPLICATION CESSPOOL!! DRYWELLO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ..ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR -
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _
t HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND I j
CALIFORNIAD AS REl THAT
BY COS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER 1
CALIFOO12 T.�AT I AM THE LE NER OF TFIr"_ .ABOV
DESCRIBED REQ IAL P OP. R BACKFILL SEPTIC TANKS❑ `
SEEP. PIT(5) Ll CESSPOOLSU i
SIGNATUR
OF PER
di ii
JOHN A. LAMBIE.COUNTY ENGW<FER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR