HomeMy Public PortalAbout5470 BALDWIN AVE_Sewer__ (2) 76A 6?2D — CE808 — 9/73 APPLIC �NFO PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING •i
ADDRESS
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. - OWNER
BLOCK TRACT ADDRESS6�7vl4 I co,rf'
NO. OF BLDGS. 1
SIZE OF LOT,5, ��) NOW ON LOT CITY — TEL. NO.
USE OF 7
BUILDINGS Ll _ - DISTRICT NO. ROUP BK MAP Pe ESSED BY
CONTRACTOR r' ��• Y, �� - �\
ADDRESS �J 2' J .(� CONNECTION DATA
CITY j A 7L( TEL. NO. STATION DEPTH
LIC UPPER
LICENSE NO:" ti (�' v CLASS �'�f MANHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $7.00
SEPTIC TANK.SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD @ 510.00 CO.IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL7 SRYRNT AFFIDAVIT WAIVER [ARECORD.INSTR.NO. DATE �..,
WORK TO HOUSE SEWER U, ® $3.00 C
OVERFLOW SEEPAGE PIT.DRAINFIELD V
EXTN..CESPAIR 0 DABANDO. $5.00 HWV.OR ST.WIDENING 7 LTi , CD
ALTER.REPAIR OR ABANDON HOUSE � U
CD
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT V
MANHOLE $7.00 PERMIT NO. LLI
INDUSTRIAL a
WASTE APPROVAL Co
z
CHARGES �...
OWNER'S PERMIT s 00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE -f
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLICSEW A�ff�
APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF LOWNER OR - j / NEW HOUSE SEWER
OWNERS AGENT f (i
f�[,. �,4tr CONNECT ADDITIONAL
ADDRESS [f' Q 0 BUILDING OR WORK l•7 '
SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE HAT I HAVE READ TH15 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 Cl DRYWELL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNy AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFCQ7NIA OR THAT 1 AM ryTHE LEGAL�,O _ ER,0 • AND INTEND TO DISCONNECT PLUG AND '
RESIDE IN, THE ABOVE SCRIBED R 5 N'�I PROPERTY. ABANDON HOUSE SEWER
A
SIGNATURE CKFILL SEPTIC TANKS ❑
OF PERMITTEE ✓'.
SEEP,PIT(S) Cl CESSPOOLS ❑
VALIDATION LK M.O. CASH
i
1 8 8 tvllG 8 10 D 1 4.0 L)
CE8083-62
76Afi42D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS Lk 0
WILLIAM A. JENSEN, Sup't of Building ,
LOCALITY ��
NEAREST
FOR APPLICANT TO FILL IN CROSS BT.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT t g�� ADDRESS �.� PL F y
J Z J NO. OF BLDGS.
SIZE OF LO . (� NOW ON LOT CITY •� TEL. NO.
USE OF `^, ►
BUILDINGS "Q DISTRICT NO. ROUP MAP PROCESSED BY
,y K PG /
CONTRACTOR #w0, C us L C, �
ADDRESS •Z �;, . LLQ ✓ CONNECTION
CITY TEL. NO.C—,1)o STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. 2 ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIONGTH FROM >'
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L. L. /ma/yy
PUBLIC SEWER @° $5.00 V
SEPTIC TANK,SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD �° $10.00 CO.IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO
TRUNK PERMIT NO. ROAD PERMIT NO. O
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT w IVE EASEMENT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 - - U
ALTER, HOUSE HWY.OR ST.WIDEN NG
SEWER M @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT S 2 00 CHAR
CONNECTION CHARGE F
AUTHORIZATION TOTAL FEE p Zt
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMeNT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEW E$.1Z n f f�� APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS •eft—/-�/�"'�/ DAY OF .�>>� IQ'��
OWNER G$ i &7Z //.a NEW HOUSE SEWER
CONNECT ADDITIONAL
ADDRESS �/ / - /L' ",Z. �L (- r- BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(S)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY F`ND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
I
CALFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND r Y
RES DE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑ _
OF PERMITTEE �i tom,/ SEEP,PIT(S) ❑ CESSPOOLS ❑
OALIDATION ROBERT A. WOOD
.KM.O. CASH SUPERVISING MECHANICAL ENGINEER
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