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Home My Public Portal About6029 AGNES AVE_Sewer_4/23/1965_ dAl 6 10 63 76A6A642D ' APPLICATION FOR PERMIT 1 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION TC O JOHN A LAMBIE County Engineer WILLIAM A JENSEN Sup t of Bu>lclmg FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO _c�e _ OWNER MAIL O� BLOCK TRACT ADORE ///---7��/ NO OF BLDGS ��j SIZE OF LOT NOW ON LOT CITY NO V L USE OF DISTRICT NO ROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY TEL NO STATION 'rJ a DEPTH ❑ STATE MANHOLE REFERENCE i REGIST ION NO El COUNTY rpm LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L } PUBLIC SEWER @ $5 0o PC NO CL SEPTICTANK SEEPAGE PIT OR JOB NO O PITS AND/OR DRAINFIELD @ S1000 CO IMP NO V/ HOU5E SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER [AS EMENT RECORD INSTR NO DATE / Q WORK TO HOUSE SEWER $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE @ $5 00O. Ll LJ ALTER REPAIR OR ABANDON HOUSE H OR ID NI G V) SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT Z PERMIT NO INDUSTRIAL WASTE APPROVAL OWNER S PERMIT E 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHAR FEE CHARGES IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER 0 OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK `J VCA ADDRESS SEPTIC TANK SEEP PIT(S) ' HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WI"H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN TH ABOV DESCRIBED RESID&WTIAL PROP TY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ElOF PERMIT SEEP PIT(5) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH �� 0 � � �U ATR 23 1 0 D 5 OG- G DEPARTMENT OF COUNTY ENG INE3M I , DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1 PERMIT APPLICATION COUN'T'Y OF LOS ANGELES WILLIAM J FOX, COUNTY ENGINEER BUILDING L �j ADDRESS96+.2 6 .0 =RAPPLjICANj_TQ FILL INLOCALITYBUILDI �/ NEAREST l V ADDRESS ` CROSS ST y DISTRICT NO Ready for Inspection� I PERMIT NO NEAREST 1-6 LOCALITY �+ 44F C J CROSS ST �✓ RECEIVED BY DATE ISSUED BY �y g�DATE OWNERMAIL ADDRESS USE ZONE '�OCCUPANCY 'INPAP— CITY TEL WO / I �" `-'� I BK Pe CONTRACTOR CO IMP NO C7U(o D ADORE j JOB NO CITY TEL.NO TRUNK PERMIT NO 8TATE / REGISTRATION NOLEG11 + COUNTYI ROAD PERMIT NO DESCRIIPTION LOT NO /yQ �Q / /C3� STATE ENCROACHMENT PERMIT NO BLOCK TRACT INDUSTRIAL� WASTE APPROVAL SIZE OF LOT NO OF BLDGS NOW ON LOT CHARGES _ USE CONNECTION CHARGEAFEE NO DESCIWPTION OF WORK FEE _ REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 3 350 RECEIPT NO { I ND91TE I BY HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR EXCTION RE RDED WORK TO HOUSE SEWER 1 00 — ALTER OR REPAIR EXISTING NO . DATE I BY SEWER OR DISPOSAL SYSTEM 1 00 DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM 109 CONNECTION DATA SEPTIC TANK SEEPAGE PIT OR � ��_ (n _ PITS AND/OR GRAINFIELD 2.00 8TATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 r P` L MANHOLE REFERENCE LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT 1 00 CURB + .-P t___P ML TO P L 3 -- AUTHORIZATION I TOTAL FEE f� ` I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE RESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THISDAY O NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL T OWNERS AGEN t - BUILDING OR WORK SEPTIC TANK SEEP PIT(8) ADDRESS ��a_ AND/OR DRAINFIELD 1 HEREBY KNOW EDGE THAT I AVE READ THIS APPLI CESSPOOL(] DRYWELL CAT IONAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COON CONNECT PLUG AND AND STATE OF CALIFO OR THAL4.AM THE LEGAL 0 ABANDON HOUSE SEWER ER OF THE ABOVE C'C NTIAL ROPERTY BACKFILL SEPTIC,TANKS SIGNATURE SEEP PIT(S)[] CESSPOOL IrS- OF PERMITTEE - - 7 76A642D S&E 663 4/6e