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Home My Public Portal About5015 BALDWIN AVE_Sewer__ (2) PF 62 76A64262 APPLICATION FOR PERM � > 6A842 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION M BUILDING JOHN A LAMBIE County Engineer ADDRES^ 01/. gE..Y WILLIAM A JENSEN Sup t of BuildingLOCALITYNEARESTFOR APPLICANT TO FILL IN CROSSSLEGALDESCRIPTION LOT NO OWNER MAILBLOCK TRACT ADDRESSNO OF BL GS SIZE OF LOT NOWON LOT CITY TEL NO USEOFDISTRICT NO GROUP MAP PRO BUILDINGS CONTRACTORf,/ BK PG ` ADDRESs� �++7CONNECTION DATA CITY TE STATION `' ^ DEPTH REGISTRATION NO ❑ STATE MANHOLE REFERENCE UPPER ❑ COUNTY ) l� NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO CURB P L M L TO P L PUBLIC SEWER @ $5 00 P C NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO U PITS AND/OR DRAINFIELD @ E1000Itla HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 [� CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ S300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE a $500 HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $1 21 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO COV NECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRE LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH A THE LEGAL OWNE F AND I TEND TO DISCONNECT PLUG AND RESIDE IN THE VE ESCRI BED RESIDE AL P OP TY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PER MITT SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD M O CASH SUPERVISING MECHANICAL ENGINEER CK LACO 1 0 9 410 FEB 19 1 0 D 7,V 0 civ