HomeMy Public PortalAbout10925 WILDFLOWER RD_Sewer__ E6cs tr-ss 6
3 a - 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 ®( '4vil �f�.ower ±gid.
JOHN A. LAMBIE. COUNTY ENGINEER aDDxsS_^, r�
CASSATTD. GRIFFIN, SUP'TO.I=BUILDING LOCALITY �emr,le v----y--.
NEAREST
FOR APPLICANT TO FILL INLEGAL _cRGss syT. vI, ,
DESCRIPTION LOT NO OWNERr� r Ur 4Ve er Construction C0
MAIL �.,•^
BLOCK TRACT `3GLy ADDRESS _-'�. - 1�' rl r „ _`in_,_�Irde_
NO. OF BLDGS; CITY San GabrieILL. NO.At 7-0531
SIZE OF LOT NOW ON LOT
-BUILDINGSUSE OF
u Residence DISTRICT NO. GROUP MAP
-- ---�-- BK PG
CONTRACTOR L r old• h". Construction
CONNECTION DATA
_ 21 '� , lr i[t ars.a ,kye. ---— —__--__ _
ADDRESS
'I;:T. ,� Cj
_STATION
DEPTH sem,
CITY '1'y".1.`�'iC�.�.la TEL. N0. "i 6 X1'1` . MANHOLE REFERENCE UPPER
'7 �ry1t /3
3613 C ` 2 ❑ STATE
REGISTRATION NO. .1
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM
- i HOUSE SEWER CONNECTING T0 Y. CURB P.L�� M.L.TOP.L.
._
-� SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD_ _ _ _ (u. $3_.00
OVERFLOW SEEPAGE PIT,DCELD -{I - P. C..NO. 1'+
EXTh ,CESSPOOL,DRYWELL,MANHOLE fci_$_2.03I^ IMP. NO. __-JOB No.
HOUSE SEWER CONNECTING TO - -
PRIVATE DISPOSAL SYSTEM Vit__$1.+30 I �' TRUNK PERMIT NO, ROAD PERMIT NO.
CONNECT ADDST_SONAL BtDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $.1.00 —_-__ PERMIT_ _NO._ _
ALTER,REPAIR OR ABANDON HOUSE
SL1JER OR DISPOSAL SYSTEM aril § r I INDUSTRIAL
'•�� -WASTE AP__ I-`---- ---- 4+/ CHARGES
CONNECTION CHARGE. FEE
OWNER'S PERMIT t OC ------ — --- ---
REIMBURSEMENT FEE
AUTHORIZATION i TOTAL FEE 4, 0 /y4p c
-I HAVE AT THIS DATE; A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS ' DATE iiNSP Ei:TOR'S SIGNATURE
TRACTOR TO CONNECT THE A30VE DESCRIBED EXISTING DWEL.LING
TO THE PUBLIC SEINER_ NEW HOUSE SEWER I
SIGNED THIS--_--_—DAY OF_ ._19CONNECT ADDITIONAL
OWNER OR '��W BUILDING OR,WORK -
OWNERS AGENT _^y-- -"-------- ._.__ --____ .._.._.- ---j-------._.�_..---------
— SEEPTIC TANK,SEEP,PIT(.S)
ADDRESSAND/OR DRAINRELD
. --_,_� `_--.____------------ -___-- --- ---------L -- _;_.._. ------------
I HLRFBY ACKNOWLEDGE THAT I HAVE READ THIS .APPLICATION
AND STATE-�THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL'L_1 DRYLVELL❑
WITH ALL CDUNTY ORDINANCES AND STATE L.',WS REGULATING ALTER,REPAIR SEWEROR I
PLU MIBINg. AND SEVERS. SEWAGE DISPOSAL SYSTEM �.
i
I HEREBY CCR IIFY THAT i AM PROPERLY REGISTERED AMC/GR DISCON -___---r------'--.---
LICENSED AS PECUiPED BY LOS ANGELES COUNTY AND STATE OF ABANDON
SPLUG AND
CALIFORNIA OR THAT I AAI THE LEGAL O� OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RES,'0ENTPROP_RTY
� ! r, B+,CKF ILL SEPTIC TANKS,J
SIGNATURE �/ SEEP. PITIS) (._, CE.;SPOOLS� I ,
- -- �---------__-
OF PERMi1'TEE
JOHN A. L_AMBIE, COUNTY ENGINEER VALID TION ROBERT A. WOOD,CHIEF PLBG. INSPECTOR
1�' N.0. CASH