HomeMy Public PortalAbout10928 WILDFLOWER RD_Sewer__ 78AE-6611-55 - APPLICATION FOR PERMIT -
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING y pyO xa} 1
.JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS L J228 Wi1d,doLCwer �W LLd,,___
FJ CASSATT D. GRIFFIN,.SUP•T OF BUILDING .�,
LOCALJTY g�p-i ,, (,•,��
NEAREST �—=�H•
FR OR ,APPLICANT TO FILL IN CROSS S'r. ���1�aX1C� ���LEGAL
LOT NG. / OWNERr� �+ yTRACTi 234 AD'-1RE55G{ �TC��� ' ., 3. BV �sSE OF
N0.OF BLDGS. CITY G� (s TEL. N0,NOW'ON LOT 2 a.3 Gn At 9-01;7�51 DISTRICT NO. GROUP MAP
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Dtruc�r }. o.
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CONNECTION DATA
ADDRESS �.
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---- T �� -- -- DEP
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CITY TEL. N0. 7rQr} -�� STAT'ION .�, r
-- w-----_— -o—_ _ _ r MANHOLE REFERENCE fUPPER" b
REGI.STRATIGN NO< - 3,�,'� �_ (3 0 STATE 41i
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NO. DESCRIPTION OF�W�O�iiK FEE - - -
- - -- ---- TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER
- SEWER CONNE(TINC O— — I - Y._ CURB M.L.70 P.L• _
PUR $ 3.5C --
IDANK,SEP:PAG�- PIT OR
PITS ITS DS AND/bR DRAiNFIELp (ri $3.00
OVERFLOW SEEPAGE PIT DRAINFIELD P. C, NO. �✓
EXiN_CESSPOOL,DRYW ELL,MAN HOL E Cr. $2.001 CO�IMP N0, JOB NO. .—
HOUSE SEVER CONNECTING TO
i PRIVATE DISPOSAL SYSTEM C $1.01011--_ TRUNK PERMIT NO. ROAD PERMIT NO.
1 CONNECT ADDITIONAL BLDG, OR � � STATE ENCROACHMENT
WORK TO HOUSE SEWER i.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE i INDUSTRIAL
SEVER OR DISPOSAL SYSTEM «i $1.0r`. iI WASTE APPROVAL
- ----— .------`---- ---"- --- I
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ I 1 1 00 - -- —--- ---- ------- -- ------
-- -__--._ .'—.-- ---- ------ REIMBURSEMENT FEE'
AUTHORIZATION TOTAL FEE � � r :
APPROVALS DATE NSPECTDR'S S;GNATURE
[ HAVE. Al' THIS DAT£ A CONTRACT WITH THE HEREIN NAMED CON- �---
TRACTOR 'CO CONNECT THE ABOVE DESCRIBED EXISTING DWCLL'NG
TO THE PUBLIC SEWER. NEW HOUSE SEWER -t
SIGNED THIS_._ .___DAY Of _._ —._.?9.___. CONNECT ADDITIONAL j
OWNER OR �'T{�� BUILDING OR WORK. �L_--
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OWNERS AGENT-- car __._.--___-_:_—._� SEPTIC TANK,SEEP, PITIS) I -
_ AND/OR_DRAINFIELD !
L
_R EHY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL(J DRYWELL STI, TH THE ABOVE 1S CORRECT AND AGREE TO COMPL'f LL COON.Y ORDINANCES AND STATE LA1:S REGULATING ALTEF REPAIR SEWER OR
ABiPC AND SEWER SEWAGE DISPOSAL SYSTEMNSED CLR.IFY 1HAT 1 AMPROPERLY P.EGIS'ERGO ATE OFCISCONNECT PLUG AND
hS .; REJU1REp 6Y LOS t,NGELES COUNTY ANp S'CATE OFFJI lA OR THAT I AM TfiE LEGA YNNER OF TIDE ABOVE ABANDON HOUSE EWERRIBED BESID '• ' BACKFI:.L SEPTIC TANKS LJIAL ? 'P TY.A'CURE SEEP. PIT ISI L. CESSPOOLS PERMJ -
JOHN A. LAMBIE,COUNTY I EER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
L�K`�`, N. 0. GASH -