HomeMy Public PortalAbout5436 BALDWIN AVE_Sewer__ (2) DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
"IDIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICA TO FILL IN LOCALITY ,
BUILDINNEAREST
ADDRESSG CR SS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.-
NEAREST A S
CROSS ST. __RECEIVED.BY-. Ready for Inspection. ___DAT-E-ISSUED____
OWNER
' I
MAIL ! USE ZONE OCCUPANCY BK MAP PG
ADDRESS
CITY TEL.NO. /r, /7-
rdd
CONTRACTOR CO.IMP.NO.
ADDRESS JOB.NO.
CITY TELAO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL �Q y., STATE ENCROACHMENT
DESCRIPTION LOT N0. [[uu PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT : NO.OF BLDGS. CHARGES
NOW ON LOT
USE OF
BUILDINGS O( /( CONNECTION CHARGE FEE ft/ "� �� 416.6ij
N0. DESCRIPTION OF WORK FEE REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 RECEIPT 0 DATE BY /
HOUSE SEWER CONNECTING TO '�"��Cj p �,� `S�� �--AYOC
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND AND/OR DISPOSAL YSTEMN SEWER 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION \ DEPTV
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHkLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 00
Y. CURB P.L. M!L.TO P.L.
`
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECT 'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS.—...DAYOF......._ —._._____19_..
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...._._._.._._._..._.._. _�__�,_•�� BUILDING OR WORK
_.._._.
SEPTIC TANK.SEEP.PIT(S)
ADDRESS..-_......_.._....__.._............................_._.._._.._...�. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL I]
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE-SEWER
AND
I
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOV SCRIBED RESIDE L OPERTY. BACKFILL SEPTIC TANKS
P / SEEP.PIT(S)[] CESSPOOLS
SIGNATURE % ����SSii 6��.�
OF PERMITTEE............-----•... .... - -.......... - - .
76A642A 663 7/53
DEPAUTAEFNT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
.DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
" WILLIAM J. FOX, COUNTY ENGINEER ` ADDRESS
FOR A.ZPL GANT TO FILL IN LOCALITY
BUILDING • NEAREST '
ADDRESS „(((��� ���/C CROSS ST. Y
LOCALITY DISTRICT NO. SERIAL NO. z PERMIT NO..
3
NEAREST S' A 4-U S
CROSS.ST. RE EIV D BY Ready for Inspection ATE ISSUED
OWNER � Q•� rvo
MAIL c
USE ZONE OCCUPANCY MK%P-'y
ADDRESS
Bfi—
CITYTEL.NO. 77, ,r�"�
i
CONTRACTOR CO.IMP.NO.
ADDRESS JOB NO. a'"�
CITY TRUNK PERMIT NO. J ajSTATE
REGISTRATION NO.
® COUNTY ROAD PERMIT NO. /� 7LP
LEGAL
DESCRIPTION LOTNOo +��������x/ STATE ENCROACHMENT
yy.�� .� PERMIT NO.
BLOCK Ov TRACi�s+�_-JSS-o,&, INDUSTRIAL
WASTE APPROVAL
SIZE 0OT � Cs �W s •-` CHARGES
USE OFF 1 % $ •w
BUILDINGS s.$� �r '-`- Yb CONNECTION CHAR E FEE
NO. DESCRIPTION OF WORK FEE V REIMBURSEMENT FEE /
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR CEPTIO RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING I D E I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
i SEPTIC TANK, OR
PS AND/OR
2.00
STATION DEPTH
CESSPOOL—O RYW ELL
j SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
7�y /, - t LOWER
b4nl
_ TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; too . Y. CURBP.L. M.L.TO P.L.AUTHORIZATION TOTALFEE 77 , C. ! s A o-a =e el 1l /'T r�
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED ' �'��F ,�� ���� r.
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APgROYALS I INSPECTOq;S,8IGNATU.RE(,DAT
DWELLING TO THE �MLIC SEWER + I--
°----- :.G. N ' HIAUSE'SEWERL���� ,n9�..�',Lei •�
SIGNED THIS__��.._ __... AY OF.... -- ...�. -
OWNER OR C ��1 NE -T ADDITIONAL
OWNERS AGENT..! BIiILDING OR WORK
��-c.y..- . sopTle IXNX SEEp�(s5"'°” '
ADDRESS........ _ - - - _.... .....•-...... -.....�. -... AND/ORDRAINFIELD
1
HER ACKNOWLEDGE THAT I 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 AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
USE SEWER
ER OF THE ABOVE DES IBED RESIDUXJAL-PROPERTY. BACKFILL SEPTIC TANKS
(// l SEEP.PIT(S)[] CESSPOOLS
SIGNATURE
OF PERMITTEE... _P._...� Pv
76A642A 663 7/53