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Home My Public Portal About4920 BALDWIN AVE_Sewer__ (2) t L51e 61 76A64261 APPLICATION FOR PERMIT 8A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A, LAMB IE County Enggi�nneer ADDRESS WILLIAM A JENSEN Sup t of 9mmMg LOCALITY �/ A op NEAREST FOR APPLI T CROSS ST - LEGAL DESCRIPTION LOT NO OWNER O BLOCK TRACT WAIL !�tf� ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE BUILDINGS DI DISTRICT NO GROUP MAP PROCESSED BY_`r r BK PC CONTRACTOR � ADDRESS CONNECTION DATA CITY TEL NO 70 7 1 DEPTH REGISTRATION NO a> D LJ COUNTY MANHOLE REFERENCE / , UPPER No DESCRIPTI N OF _ FEE (� PUBLIC SEWER CONNECTING TO @ $3 00 TYPE OF SEPTIC TANK SEEPAGE PIT OR Y CONN CTNPL MEL OM TOHPFLe PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD } EXTN CESSPOOL DRYWELL @ $2 00 n HOUSE SEWER CONNECTING TO P C NO O PRIVATE DISPOSAL SYSTEM @ $t 00 CO IMP NO JOB NO V CONNECT ADDITIONAL BLDG ORTRUNK PERMIT NO ROAD PERMIT NO WORK TO HOUSE SEWER 41 00 O SEWER OR DIISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT PERMIT NO W INDUSTRIAL Ii WASTE APPROVAL Z CHARGES OAR$ PERMIT 3 2 00 CONNECTION CHARGE FEE - AUMORMAnON I TOTAL FES REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OR 19- NEW HOUSE SEWER r r/lv*lL- OWNER OR CONNECT ADDITIONAL B f OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD LDESCRIBED EBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR G AND SEWERS SEWAGE DISPOSAL SYSTEM EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑ ED RESIDE IAL PROPRE SEEP PITS CESSPOOLS MITTE VALIDATION ROGE ,4 WOOD ca w 0 CASH SUPERVISING MECHANICAL ENGINEER L 5440 ; NOW 24 s D 500 � f 61 76A64261 APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING 41F r JOHN AALA County Enggi�nneer ADDRESS WILLIAM A JENSEN Supt of Im-Mg LOCALITY NEAREST FOR APPLICANT TO F94dW,, CROSS ST LEGALOWNER DESCRIPTION LOT NO BLOCK TRACT MAIL ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS Y,4 DISTRICT NO GROUP MAP CESSED BY CONTACTOR 6flaL � �D BKS ADDRESS 4 11glij ti CONNECTION DATA CITY L NO l� !PT[ON DEPTH REGISTRATION NO A LJ COUNTY MANHOLE REFERENCE UPPER No I DESCRIPTION OF WORK FEE HOUSESEWER CONNECTING TOPUBLIC @ $S 00 6b SEPTIC TANK SEEPAGE PIT OR Y TYPE OF CON E NGTH P L MEL TOPFLOM °Z T PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ S2 00 d HOUSE SEWER CONNECTING TOyy�� P C NO O PRIVATE DISPOSAL SYSTEM @ $100 CO IMP NO D' JOB NO U CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO w WORK TO HOUSE SEWER @ SI 00 O SEWER OR P IR R A STEN HOUSE @ $I 00 STATE ENCROACHMENT (— PERMIT NO W INDUSTRIAL d WASTE APPROVAL Z CHARGES Qvi 'S' PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE T HAVEACTOR TO CIONNECT THE ABOVE DESCRIBED EXA CONTRACT WITH THE IST NGAMED CONDWELLING APPROVALS DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 9_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD LANDAEBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR G AND SEWERS SEWAGE DISPOSAL SYSTEM EBY CERTIFY THATI AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER NIA OR THAT 1 AM TH GAL OW ER OF THE ABOVEBACKFILL SEPTIC TANKS ❑ED RESID TIAL POPER / SEEP PIT S ❑ CESSPOOLSREMIT E VAIMATION RO13E T A WOOD Y 0 CASH SUPERVISING MECHANICAL ENGINEER � (3 5 4 4 1 eau 2 4 1 1 D 2500 F Aw/��lnl »� "'tea 61 76A64261 APPLICATION FOR PERMIT 8A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Enneer ADDRESS WILLIAM A JENSEN Sup t of Building _ LOCALITY NEAREST FOR APPLICANT TO FII.L CROSS ST DESCRIPTION LOT NO 9f + OWNER 14L � BLOCK TRACTMAIL i_ ADDRESS —NO OF BLDGS av SIZE OF LOT 1 NOW ON LOT CITY TEL NO USE / DISTRICT NO GROUP MAP CESSED BY BUILDIDI NGS BK PG CONTRACTOR 7 �! o t V ADDRESS CONNECTION DATA IV CITY TEL NOAl STA ON DEPTH q A/ 13 STATE_T REGISTRATION NO COUNTY MANHOLE REFERENCE UPPER No I DESCRIPTION OF _WORK FEE HOUSE SEWER CONNECTING TO �) PUBLIC SEWER @ $3 00 (J V TYPE OF CONNEC LENGTH FROM vv�� SEPTIC TgNK SEEPAGE PIT OR Y C P L M L TO P L OC ITS AND/OR DRAINFIELD @ $H 00 OVERFLOW SEEPAGE PIT DRAINFIELD >_ EXTN CESSPOOL DRYWELL @ 32 00 CL HOUSE SEWER CONNECTING TO Cl B NO PRIVATE DISPOSAL SYSTEM @ S1 00 CO IMP NO om- JOB NO V CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO CK WORK TO HOUSE SEWER @ S1 00 O SEWER OR PAIRO R A SYSTEN HOUSE @ sl 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL W a WASTE APPROVAL N CHARGES Z OWM S PERIY= g 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER Z_ SIGNED THIS DAY OR 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL ° (� OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD LDAEBY ACKNOWLEDGE THAT { HAVE READ THIS APPLICATION TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR G AND SEWERS SEWAGE DISPOSAL SYSTEEBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER NIA OR THAT 1 AM THE GAL OWNER OF THE ABOYE ED RESIDE AL PROPERT BACKFILL SEPTIC TANKSRE SEEP PIT ❑ CESSPOMITTEp�..y CLq� ,,--�ALIDATION ROBERt A WOOD C6.// tl 0 CASH SUPERVISING MECHANICAL ENGINEER 5442 NOV 24 i +� 0 500 � 4c f 61 76A64261 APPLICATION FOR P RMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWACIE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING l JOHN A, LAMBIE County Engineer ADDRESS I WILLL4M A JENSEN Sup t of BuildgLOCALITY NEAREST FOR APPLICANT T F l CROSS ST FSIZE GAL OWNERIPTION LOT NO �� TRACT MAIL ADDRESS NO OF BLDGS F LOT NOW ONLOT CITY TEL NO USE DI DISTRICT NO GROUP MAP P SED BY BUILDINGS BK PG CONTRACTOR L ADDRESS COMNECTION DATA CITY L NO TION DEPTH REGISTRATION NO JT�ATECOUNTY MANHOLE REFERENCE UPPER No I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO 6 PUBLIC SEWER @ $3 00 TYPE OF CORN T LENGTH FROM ,�{ w{ SEPTIC TANK SEEPAGE PIT OR Y M L TOP L OC 6C PITS AND/OR DRAINFIELD @ $S 00 OVERFLOW SEEPAGE PIT DRAINFIELD )- EXTN CESSPOOL DRYWELL @ $2 00 CL PRIVATE DISPOSAL SE SEWER YST0 EM TING TO @ $1 00 CO IMP NO JOB 0 CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO WORK TO HOUSE SEWER $t 00 SEWER 0 EPA P ALB TEN HOUSE @ $1 00 STATE ENCROACHMENT o PERMIT NO 1tL, INDUSTRIAL CL WASTE APPROVAL to CHARGES Z OWNER S PERMIT S CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER -- SIGNED THIS DAY OF 19- NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD LANAEBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR G AND SEWERS SEWAGE DISPOSAL SYSTE EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND D AS REQUIRED BYLOS A LESCOUNTY AND STATE OF ABANDON HOUSE SEWER NIA OR THAT 1 AM THE L GAR OF THE ABOVEBACKFILL SEPTIC TANKSED RESIDE IAL P PERRESEEP PITS ❑ CESSPOOLSMITTE ATION ROBERT A WOOD CL u 0 CASH SUPERVISING MECHANICAL ENGINEER U,C 5 4 43 � NOV 2 4 � � 0 2 5 0 0 to