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HomeMy Public PortalAbout10935 WILDFLOWER RD_Sewer__ 76A542D - APPLICATION FOR PERMIT - 1 i$Fi-6d�19-55 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDIN q - Rd JOHN A.LAMBIE, COUNTY E:iG!NEER ADDRESS-01)35 +r w CASSATT D. GRIFFIN, SUP'TOF BUILDING LOCALITY Tprn e=ty NEAREST FOR APPLICANT TO FILL IN CROSS ST. .�;_7 1 ,,A LEGAL DESCRIPTION LOT NO. _�-y-, OWNER j� B. 7ebe CQms�yr'�(+,'tign C BLOCK TRACT 299 MAIL Gabriel < y, Blvd. y .ADDRESS r)L �'"). 1Tc'�.c'.L1.ri el Zvd r N0. ON LOT OF BLDGS. SIZE OF LOT NOW CITY n TEL. N0, USE OF-^ -^� -- - BUILDINGS --_T.'ch i {�j��.�a-n n DISTRICT NO. GROUP MAP ---- - - —v B K PG CONTRACTOR L D -' r ADDRESS jt _- CONNECTION DATA I, vy�1 �l STATION -z' " r'- DEPTH " CITY r'i '�(„c'�'s�Ld.. TEL.NO. J.� • 38 MANHOLE REFERENCE UPPER 113613 0 STATE REGISTRATION NO. _ C Y NO. J DESCRIPTION OF WORK FEE --------- ----- -- HOJSE SEWcR CONNEC.TrNG 70 TYPE OF CONNEC'TION,s ;; LENGTH FROM PUBLIC,SEWER __ __-_@ $3.50, 650 -Y'--- CURB .L., M.L.TO P.L. , SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIE_LD $3.00 ------- --- _---�_- �_.- _ -- _� OVERFLOW SEEPAGE PIT.DRAINFIi_LD _-----r_---- --- P. C, NO. 1 - E TN.,_CESSPOOL,DRYkVELL.NANH.JL_E Q $2..0.01 _��- -C0_IMF. NO. JOB NO. HOUSE SEWER CONNECTING TO T �I PRIVATE DISPOSAL SYSTEM _ ra. $_1.0_0__ � IRUNK PERMIT_NO. ROAD_ PERMIT_NO. "-- 1! CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE. SEWER Get. $1,.00 PERMITNO. -. ALTER.REPAIR OR FANDON HOUSE SEWER'OR DISPOSAASYSTEM 2 $1.00 IINDUSTRIALS -.- -- .- -- -._.._.. - ..-- - __ - ..._.- WASTE APPROVAL I I CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT n0 -"-— —.-— -- -- --- w 1_ 9 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE � �� 1 HAVE AT THISDATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR`SSIGN ATURE TRACTOR TO CONNECTiliE ABOVE DESCRIBED EXISTING DWELLING _._._-------- -- - ----.._ i ___.-_. _--_-------- TO THE PUBLIC SEWER. NEW HOUSE SEWER .. SIGNED THIS------DAY OF---.---,. CONNECT ADDITIONAL -- — T" - BUILDINGOR WORK OWNER OR New --- _ ---------- _..,---.-.__ ._ OWNERS AGENI____ I --- EPTLC TANK.SSFP, PITIS AD DRESS—.—.-_-----_----_-__-- AND,'UR OF i.tt F.kL© _.-.-- 1 H'EFIESY ACKNOVILEO G E THAI I HAVE READ THIS A.PPLiCATIGN CESSPOQL G ORYW ELL(.,.J I A AND ­..t --,!.T .HE ABOVE iS CORRECT AND AGREE TO COMPLY 2tit"iH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR �I P LI;KFI.NG AND SEINERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I r _.....-.._ _ _. .�M PROPERLY REGISTERED ANC%OR DISCONNECT PLUG AND I LICENSED A'S REQUIRED BY LOS ANGELES -OUNTY AND STATE OF CALIFORNIA OR THAT I AM THE Lr' E 0 Nc OF THE. ABUVE ABANDON HOUSE SEWER DESCRIBED RESIDE'W IAL P 'P -.TY. 3 BACKFII L �-PTIC TANKS❑ I ` - / - SEEP. P l _�_L..1 CESSPOOLS„_I __. _.--- SIGNATURE � ----OF PERMIT - IOHN A. LAMBIE, COUNTY ENG EER VALIDA`T'ION ROBERT A. WOOD, CHIEF PL13G. INSPECTOR 0. CASH - -