HomeMy Public PortalAbout10932 WILDFLOWER RD_Sewer__ APPLICATION FOR PERMIT
i&E-663 7798 -
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDGO� �t
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESSING
32 Wildflowerla a
�1 CASSATT D. GRIFFIN, SUPT OF BUILniNG LOCALITY T_.._Cmnl�Cty
NEAREST '-'Vel.land Ai e.
FOR APPLICANT_ TO FILL IN _CROSS ST.
LEGAL
DESCRIPTION LOT NO. 10 OWNER_-- J. e �ffebe ' CoIlstruCtion •
BLOCK TRACT MAILADCRESSrn, Q,�'bripl
- N0.OF BLDGS. ..._ C1TY 7`J6"3,,, ` "s U .O1.TEL.hdQ. 4r f(-0531
_SIZEr OF LOT i_ NOW ON LOT - _
USE OF .,
BUILDINGS _ ��- '6 Fye_- DISTRICT N0. �! GROUP BK MAP PG
coNTRAcra Y D v l® ` ons.'ruction 06
CONNECTION DATA
ADDRESS -,c'1'r i n Ave, ---� � ----- -
.�AA� G D __STATION_ DEPTH
1Y,
CITY Arcadia,adi� , TEL. NQ. Hi6® f (J
---— - MANHOLE REFERENCE - UPPER
C1 STATE _ .ate➢ �.,a' + '
REGISTRATION NO_— j_ 4
NO. i DESCRIPTION OF WORK FEE - ---- ------
-f --- --- ----------- -- TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECI'iNG TO
j PUBLIC SEWER _ _ C $3
- .50 V Y' CURB P:L,'` M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD__ _([c $3.00
- OVERFLOWS
PIT DRAINFIELD P. C. N0. —
tXIP{ ,.CES POu.L,.bRYW FLL;MAN H Lf (4) $2.00 CO, IMP. PJO, JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL DISPOSAL SY TEM $1,10 TRUNK PERMIT NO, ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.OR I STATE ENCROACHMENT - - - -_-"--
4YORK TO HOUSE SEWER (Gil $1:0a PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSEINDUSTRIAL
j
SEWER OR DISPOSAL SYSTEM G $-1_C70,I..-- I -_-- WASTE APPROVAL -
I ---- �_ CHARGES
--_ __--- - --------- -_-.. CONNECTION CHARGE FEE
i
OWNER'S PERMIT --- – - --- ---—'- ---- ---
DD--- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE � ��,50
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS I DATE INSPECTOR'S SiCNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING- DWELLING t
TQ THE PUBLIC SEWER. NEW HOUSE SEWER -
SIGNED 1`HIS-.. ,.DAY OF _-_-_- Ig
CO- --- -----
NNECT ADDITIONAL - I
OWNER OR BUILDING OR WORK j
UWNER5 AGENT_----T, — ---- ---___
SEPTICTANK SEEP,PIT(S)
ADDRESS-- AND/OR DR IP f ELD j
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL LJ DRYWELL 0
A.tD STATE THAT [HE ABOVE IS CORRECT AND AGREE TO COMPLY
W' H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR I.
PLUMBING GIBING AND SE'4ERS, SEWAE DISPOSAL SYSTEM
1 H RVy CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -._.__G _. _.._. --- _--_-- --- -'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE; DISCONNECT PLUG AND
R. THE:
- F
CALIFORNIA OTIzAT I AM THE LF,..G� OWNER OF TIi E: PxBOVc. ABANDON HOUSE SEWER I
-_DESCR'_BrD REST TIAL PRQPERTY�/' rr A �'' BACKFILL SvPTJC TANKS❑
SIGNATURE '- , SEEF, PIT(S1 CESSPOOLS❑ I _-------.----- _--..__
-OF PERM -
IOHN A. L_AMBIE, COUNTY EN NEER VAIJDATION ROBERT A. WOOD, CHIEF PL8G. INSPECTOR
M.O. CASH
A 45