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HomeMy Public PortalAbout10831 ARROWOOD ST_Sewer__ CE808 10-63 76A642D APPLICATION f'l PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BU1LOING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALi NEARE T FOR APPLICANT TO FILL IN CROSS LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLOGS. -/ a SIZE OF LOT NOW ON LOT CITY TEL USE OF j D - - - :......ROCESSED BY BUILDINGS DISTRICT NO. GROUP MAP P {�. CONT-1— A 2 ONTRALTOAD s p �a SON ECTION D!l/ATA C V EL. NO. O—SMAKTE DEPTH _ / PER REGISTRATION-NO. 7.-212-- O NTY MANHOLE RREEF'ERENCE ^ UPS NO. DESCRIPTION OF WORK FEE TYP44 ONN CT LENGTH FRO/M HOUSE SEWER CONNECTING TO © -P.L. M.L.TO P.L. PUBLIC SEWER C $5.00 d P.C.NO. SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO. ,108 NO O PITS AND/OR DRAINFIELD Q $10.00 HOU 5E SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM @ $3.00 w CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD. INSTR.NO. DATE O WORK TO HOUSE SEWER @ S3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD LU =OVERFLOW DRYWEL L.MANHOLE @ 55.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING H SEWER OR DISPOSALS STEM $3.00 STATE ENCROACHMENT _z PERMIT NO. INDUSTRIAL WASTE APPROVAL ,r 1' L ;�•� ILICENSE WNERS PERMIT $ 2 00 CHARGES ! THORIZATION TOTAL FEE �O CONNECTION CHARGE FEE VE AT THIS DATE A CONTRACT WITH HEREIN NAMED CON. REIMBURSEMENT FEE TOR TO CONNECT HE ABOVE DES IB D EXISTING DWELLIN HE PUBLIC SEW APPROVALS DAT INSPECTOR'S SIGNATURE NED THIS D F 1 ER OR �� NEW HOUSE SEWERERS AGENT CONNECT ADDITIONALBUILDING OR WORK 'RESSHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYAND�OR DRAINFIELD ALL COUNTYORDINANCES AND STATE LAWS REGULATING MBING AND SEWERS. CESSPOOL ❑ DRYWELLHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR NSED AS REQUIRED LOS ANGLES COUNTY AN STATE OF SEWAGE DISPOSAL SYSTEM IFORNIA OR THAT I. THE L GAL OWNER OF, A INTEND TO DISCONNECT PLUG AND DE IN, THE ABOV ESCRI D RE D NTIA P ERTV. ABANDONHOUSESEWER ATURE GBACKFILL SEPTIC TANKS ❑PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER L ri,a 3 3 6" i'I 5 1 0 A '7.0 0 0-63 76A6420 APPLICATION FOR PERMIT . COUNTY OF LOS ANGELES. SEWER-SEWGE DISPOSA DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING L� JOHN A. LAMBIE, County Engineer ADORESs WILLIAM A. JENSEN, Sup't of Building LOC i Y «,,., .. ,.. r... -....,.. - NE T f FOR APPLICANT TO FILL IN r LEGAL DESCRIPTION LOT NO. OWNER i MAIL �I BLOCK TRACT Il�,j�jJ�l4/37 ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP J 'MAPJ PROCESSED BY BUILDINGS B CONTRAPG CTOR l ADDRESS �J _ �121ON CTION DATA t r r DEPTH O 5 TION •.E C EL. NO. J T% -1\ s STATE UPPER REGISTRATION NO. Q �/ COUNTY MANHOLE REFERENCE �.p 14 NO. DESCRIPTION OF WORK FEE TYPCONN T I LENGTH FROM HOUSE R SEWECONNECTING TO Y. C P.L. M.L. TO P.L. ` d PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. O CO:IMP. NO. '.108 NO. V PITS AND/OR DRAINFIELD @ $10.00 /JJ HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. �� im PRIVATE DISPOSAL SYSTEM @ $3.00 0 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAIVEp I EASEMENT RECORD.INSTR.NO. DATE I- WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT.DRAINFIELD I.LJ EXTN.,CESSPOOL,D W L ANHOLE @ $5.00 AtT-ER. EPAI R HOUSE HWY.OR ST.WIDENING H SEWER O PO L EM @ $3.00 STATE ENCROACHMENT /7 PERMIT NO. 1 L� INDUSTRIAL ✓ / WASTE APPROVAL O .� „ 1 ^� ll CHARGES OWNER'S PERMIT s CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE '1 HAVE AT THIS DATE A CONTRACT WITH T EREIN NAMED CON. REIMBURSEMENT FE T T £ ABOVE DESC EE TRACTOR TO CONNEC - EXISTING DWELLI G 'i TO THE PUBLIC SEWE APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF •-�� 1 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(5) �CIJO) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGV PLUMBING AND SEWERS. CESSPOOL El DRYW ELL El IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR a ALTER,REPAIR,SEWER OR / f� q LICENSED AS REQUIRED BY LOS ANGLES COUNTY AryD STATE OF SEWAGE DISPOSAL SYSTEM lJN CALIFORNIA OR THAT 1/,<M THE EGAL OWNER OF. D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO DESCR D 51 ENTIiAL ERTY. ABANDON HOUSE SEWER - SIGNATURE `� 3 BACKFILL SEPTIC TANKS ❑ OF PERMITTEE f SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION-----,, ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH tifiuo 4 3 3 7" Al II, .5 11 A 25-00— ` CESOS-8.88 AP LOCATMN FOR. Il ERWYJ T ' COUNTY OF LOS ANGELES SEWER—SEWAGE ®OSP®SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION AD ES G ADDDRES JOHN A. LAMBIE. County Fmgineer'. S d a 1�P 1�O �.Cj.� �• CASSATT D. GRIFFIN. Sup't of Building LOCALITY .-n- le C' m..._ s -:=..a,s ,= ...4 h.:,.:.. -.,:.r'e, NEAREST FOR.APPLICANT TO FILL IN ceoss ST. LEGAL (, DESCRIPTION LOT N0. OWNER�YI�SMCLS + C�;ti+1CI F IS ie t^'•8wtchee 'r BLOCK TRACT MAIL ADDRESS W O /W p7sth� OF SIZE OF LOT ) ZW ON LOTS f40CITY /1 l� EL.NO.. 1{+' v J ` USE OF BUILDINGS DISTRICT NO.fl GROUP MAP PROCESSED BY PG CONTRACTORS ADDRESS �, J CONNECTION DATA CITY TEL.N0. �p STATION DEPTH 4 STATE MANHOLE REFERENCE UPPER a REGISTRATION NO. ❑ COUNTY LOWER, NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $9.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR - Y. CURB P.L. M L.TO P.L. PITS AND/OR DRAINFIELD @ $8.00 OVERFLOW SEEPAGE PIT, DRAINFIELD' EX TN.,CESSPOOL,DRYWELL,MANHOLE @`$2.00 ' HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. ? WORK TO HOUSE SEWER - @ $1.00 ALTER,REPAIR OR ABANDON HOUSE STATE ENCROAC T SEWER OR DISPOSAL SYSTEM @ -$1.00 PERMIT.NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT s 2 CO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. '; APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC ER, OF e .er-06ev l 4NEW HOUSE SEWER THIS A OWNER OR •• ` CONNECT ADDITIONAL OWNERS AGENT/ 7 J �r�%� BUILDING OR WORK S z (Ja�J t SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION AND-STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑ WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ''. ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE�DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR " DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER ;. CALIFORNIA OR THAT I AM THE LEGAL OWNER. OF, THE ABOVE DESCRIBED ESIDENTIPC PROPERTY. BACKFILL SEPTIC TANKS[IT ` SEEP. PIS) ❑ CESSPOOLS'❑ SIGNATURE OF PERMITTE ®e VAIMATIO ROBERT A.WOOD gg� tl,g, �pgg SUPERVI8ING.MECHANICAL ENGINEER LAC0 3 3 2 9 �cP 3 0 1 0 A 3.00 19