HomeMy Public PortalAbout10929 WILDFLOWER RD_Sewer__ '$A
6-669 91-SS 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 v ,
JOHN A. LA1vIBlE, COUNTY ENGINEER ADDRES! 101;29 YYj �1.e .LL{ r
CAS-SAT'T D. GRIFFIN, SUPT OF BUILDING LOCALITY Templee Gi.pj df t Qy -
NEAREST
FOR _APPLICANT TO FILL IN CROSS ST. AI j:-'n(LEGL
,iL€rA
DESCRIPTION LOT NO• ---- _OWNER J. D. ?Vetbr Construction C
BLOCK TRACT 23949 MAIL
ADDRI��'V 1, San Y6 �]'?�7 ,p l .C3iy
NO. OF BLDGS. -�-r-l- .�+
SIZE OF LOT NOW ON LOT CITY G 'I L. N0.slk ?-05751
USE OF DISTRICT NO. .GROUP P MAP
BUILDINGS TTpjp�, n _ I BK PG
_C.ONTRACTORL, D M. "ons t 'uCtion Co Z� ..-
--- _ ----
ADDRESS 21 s`q a 1i9 i��^.Ssc��.'�..c�. Ave.y CONNECTION DATA i _— —
STATION --.1� L DEPTH
CITY�.r,�. .1 -� TEL. NO. +Ji. (1-- , � UPPER
-
—MANHOLE REFERENCE
❑ STATE ~
REGISTRATION NO. 11-361 C 42
Na. DESCRIPTION OF WORK FEE
ry TYPE OF CONNECTION LENGTN FROM
—I HOUSE SEWER CONNECTING TO ----- 3.50 f 3�5 -Y_ -,_--- CURB__- e'.L.J M.L.TO P.L=,�
_FUBLIC SEWER fcJ s -- --
SEPTIC TANK SEEPAGE PIT OR
lip
NO
EXENFCOSSPOOL DRYW SEEPAGE PWEDLLRMANFIELD 14OLL $2.00 �- - CO. _ .. JOB_NO,
-a- F
_ 1 _---ESYSTEM '—�--t31 °x_ 9.00 TRUNK PEERMITNO..---.-- ROAD,PERMIT NO.
ROUSE_EWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM (" L._r.
CONNECT ADDITIONAL BLDG,.OR STATE ENCROACHMENT'
WORK TO HOUSE SEWER C` $___1I.PO I I PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
_-_�-
SEWER DISPOSAL SYSTEM j i.OJ. WASTE APPROVAL
CHARGES
_. CONNECTION CHARGE FEE
OWNER'S PERMIT -- 4 ---- ----- -- --- —-
1� OO
I
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 4b ---_
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COIN- APPROVALS L DATE 1INSPEC'OR`SSIGNATURE
TRACTOR TO CONNECT THE APCVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC. SEWER. - NEW HOUSE SEWER I -
SIGNED THIS --DAY OF----.-19--- CONNECT ADDITIONAL
OWNER OR -3UfL[)iNG OR WORK
OWNERS AGENT— ._.._,_ I
�--- SEPT! TANK,SEEP,PIT(SS I I
AN6iOR DRAINFIFLLI
' I-I EBERY ACK.OW LED GE THAT I HAVE READ THIS APPLICATION
AND STATE THAI THE ABOVE IS CORRE.Ct AND AGREE TOCOMPLY aESS]OOLL_f DRYWELL L_
_. '!. I
. . _ ____ --_._--- - — —-__ _-. -----_r_.__
WITH ALI. COUNTY ORDiNANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS. _SEWAGE.DISPOSAL_SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ^
LICENSED AS REOU,JRED BY LOS ANGELES COUNTY AND SDISCONNECT PLUG AND
TATE OF
CALIFORNIA OR THAT I AN HE LEGAL VNER OF THE ABOVESL
ABN DON HOU SEWER
DESCRIBED RESID AL PR E_ .,z >fi BACKFILL SEPTIC TANKS E,
SIG.NATUR£!yT .. ;- SEEP. P1TiS) I.? CESSPOOLS❑ JI —
OF PERM Ilk
t�
JOHN A, LAMBIE.COUNTY ENGI ER ,,:1ALIDATION ROBERT A. WOOD, CHIEF f LBG, INSPECTOR