HomeMy Public PortalAbout5041 BALDWIN AVE_Sewer__ (2) DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 7
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING .-,/
ADDRESS �/c7/"J1>
F R APPLICANT TO ,FI L IN , LOCALITY
BUILDING /') NEAREST
ADDRESS CROSS ST. -- '
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTA J/ S
CROSS ST. _
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USEZONE OCCUPANCY MAP
ADDRESS 1_, BK PG
CITY ��-«_. TEL.NO.
CONTRACTOR
� CO.IMP.N0.
ADDRESS
JOB NO.
•y h
CITY TEL.NO. � / TRUNK PERMIT NO.
STATE
REGISTRATION NO. U COUNTY ROAD PERMIT NO.
LEGAL E y/8752. L o7 z S y /,�
R 1:A2 Ther STATE ENCROACHMENT
DESCRIPTION OTNo'?
r PERMIT NO.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT NOW
�J NO.OF BLDGS. WASTE APPROVAL
- ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK_ FEE
HOUSE SEWER CONNECTING T REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
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 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION �; DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 '31? MA UPPER EFERENCE
TYPE OF CTION LENGTH FROM
OWNERS ; I oo �+- M.L.TO P.L. �.�AUTHORIZATION [PERMIT
TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS -DAY. OF-------------__--------.-------------- 19..-.-.-- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.----.-LJ K... _. k:.:._......-.--..........................-.....-------• AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL
CATION AND 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[:] CESSPOOLS tiy,
OFPERMITTEE......-------------__---------------_----- ----------------------------" `
_ 6-121) fiiJ, 1/53
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FDR APPLICANT_ TO FILL IN LOCALITY }l
BUILDING /J NEAREST
ADDRESS vv (J'-� CROSS ST.
LOCALITY
DISTRICT NO. SERIAL NO. PERMIT NO.
���:•�✓• C
NEAREST '' A S
//G
CROSS ST. {
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER Y MAILf.:
ADDRESS f ( USE ZONE OCCUPANCY MAP
BK PG
CITY TELAO.
CONTRACTOR CO.IMP.NO.
ADDRESS / 14
JOB.NO.
CITY , ?: j TEL.NO. TRUNK PERMIT N0.
,r i J' ❑ STATE
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO. "
LEGAL
DESCRIPTION LOT N0. �' l STATE ENCROACHMENTPERMIT NO. _
BLOCK TRACT INDUSTRIAL
' WASTE APPROVAL
SIZE OF LOT `� ' NO.OF BLDGS.
NOW ON LOT CHARGES
USE
-BUILDINGS CONNECTION CHARGE FEE
NO. I DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1,00
ALTER OR REPAIR EXISTING NO. DATE BY
SEWER ODISPOSAL SYSTEM I.00
R
DISCONNECT AND ABANDON SEWER
AND_/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR �j
PITS AND/OR DRAINFIELD 2.00 I STATION 43�Ja DEPTH A15
SPECIALCONDITIONS ONLY 2.00
/J MANHOLE REFERENCE
TYPE OF CONNECTION LENGTH FROM 90
Y. -POW M.L.TO P.L.
OWNERS PERMIT $ I 1 00
AUTHORIZATION I TOTAL FEE I -
CONTRACTORHAVE
TO CONNECT DATE THEED TOABOVE DESCRIBED I EXISTING AED PPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------------------DAY OF.......
--_.............................19...
_... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........._......-- Y BUILDING OR WORK
......-----•-----••------------•-----------------_- SEPTIC TANK,SEEP.PIT(S)
ADDRESS-------- ------••-•------------..................................................... AND/OR DRAINFIELD
CAI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL E]
TIONAND 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
1 R LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/011 DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
i SEEP.PIT(S)fE CESSPOOLS
SIGNATURE
OFPERMITTEE--------------------------.......-.......-.....-------__-----------------
76A642D 663 1/53 F_o-