The URL can be used to link to this page

Home My Public Portal About10832 ARROWOOD ST_Sewer__ e o , e s. - 76A64 5-65 • APPLICATION PPI ICATION FOR PERMIT 76A 642D /"i L t.+PY �V f'C�VI _COUNT'y OF-LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. L.AMBIE, County Engineer ADDRESS / COLEMAN W. JE:NKINS,Supt. of Building LOCALITY P NEAREST f FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO, D OWNER MAIL ^ r l BLOCK TRACT S 6 2 ADDRESS NO. OF 13L GS. SIZE OF LOT NOW ON LOT CITY ,� TEL. .NO. USE OF BUILDINGS DISTRICT NO. GRO MAP PROCESSED BY /}�J B K P G CONTRACTOR V I v `— J Q/ ADDRESS CONNECTION DATA STATION DEPTH CITY TEL. NO. LICENSE LICENSE UPPER NO. CLASS 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 2 $ 5.00 SEPTIC TANK, SEEPAGE PIT OR P.C.NO. d -' PITS AND/OR DRAINFIELD C $1 0.00 CO.IMP. NO. JOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM C' $ 3.00 CONNECT ADDITIONAL BLDG. OR EASEMENT RECORD. INSTR.NO. DATE WORK TO HOUS =WAIIE!kE SEWER C $ 3.00 O A , REP-A-11FOR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM C $ 3.00 7c-ow 11AIN1,11. HWY.OR ST.WIDENING d. E%TN„CESSPOOIA. MANHOLE @ $ 5.00 STATE ENCROACHMENT PERCOLATION TEST C $ 5.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL __4CHARGES PERMIT s z 00 CONNECTION C RGE FEE A �HOIUMION TOTAL AE '1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT 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 BUILDING OR WORK ADDRESS 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - ALTER,REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOES G ED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ - SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK. M.O. CASH Y LA 1 1 7 2° AL 5.00 v 6A642 0-63 APPLICATION PP ICA TION ICO® PERMIT 7 6 A 642 D P"i I� IL P1 1 I tl lI IfY f�IG fY COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY . �... - r. ...,. ,._... ..__..,.`�_.. x. NEAREST FOR APPLICANT TO FILL IN `ROSS ST. LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT � 2,0 ADDRESS (/ NO. OF BLDG /1/C�C +-• SIZE OF LOT NOW ON LOT CITY /7 TEL. NO. USE OF DISTRICT Nk GROUP MAP BY 'I BUILDINGS PG�• CONTRACTOR ADDRESS CONNECTION DATA J CITY TEL. NO. STATION DEPTH %� ❑ STATE '7 MANHOLE REFERENCE UPPER REGISTRATION NO. El COUNTY. Q1AeC-4�� NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO J Y. CURB P.L. M.L.TO P.L. } PUBLIC SEWER @ 55.00 P.C.NO. CL SEPTIC TANK,SEEPAGE PIT OR0 PITS AND/OR DRAINFIELD @ SIO.OD CO.IMP. NO. S ) JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE O WORK TO HOUSE SEWER @ S3.00 V OVERFLOW SEEPAGE PIT,DRAINFIELD IJJ EXTN.,CESSPOOL.DRYWELL.MANHOLE @ $5.00 HWY.OR ST.WIDENING ALTER,REPAIR OR ABANDON HOUSE N SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT z PERMIT NO. INDUSTRIAL _ WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE / 0..if7 CONNECTION CHARGE FEE [AND VE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- REIMBURSEMENT FEE TOR TO CONNECT THE ABOVE DESCRI D EXISTING DWELLING HE PUBLIC SE EFj� APPROVALS DATE INSPECTOR'S SIGNATURE NED THIS (,/ AY OF ^'� 19ER OR NEW HOUSE SEWER O ,ERSAGENTCONNECT ADDITIONAL BUILDING OR WORK ESSSEPTIC TANK.SEEP.PITS) EREBY ACKNOWL DGE THAT I HAVE READ THIS APPLICATION gND/OR DRAINFIELD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑EREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR NSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND DE IN, THE ABOVE DESCRIBE RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER ATURE � BACKFILL SEPTIC TANKS PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATIO ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH a00 3 .8 6% JM23-1 0 0 7.00- IV CE808 3-64 q p p ry� w' /® p ❑p rye+ 76A642D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION eU ILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building LOCALITY a-...:e -.. NEAREST FOR APPLICANT TO FILL IN =R°55 ST. LEGAL ! DESCRIPTION LOT NO. 6 OWNER MAIL n BLOCK TRACT ii ADDRESS 3 p[ NO. OF SLOGS, SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF - , BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY BK PG/ CONTRACTOR � r ADDRESS CONNECTION DATA CITY 41� TEL. NO. STATION DEPTH ❑ UPPER STATE 1 J MANHOLE REFERENCE y REGISTRATION No C3 COUNTY 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 @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. CL PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. .108 NO. 0 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, O PRIVATE DISPOSAL SYSTEM $3.00 U CONNECT ADDITIONAL BLDG.OR I_� AFFIDAVIT WAIVER EAEIMINT RECORD,INSTR,N DATE WORK TO HOUSE SEWER $3.00 O OVERFLOW SEEPAGE PIT,DRAINFIELD I— EXTN.,CESSPOOL,DRYWELL,MANHOLE $5,00 V ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING CL a SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT - h PERMIT NO. Z INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT $ 21 00 CHARGES AUTHORIZATION TOTAL FEE ��/y CON NECTI CHARGE FEE 'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• REIMS RSEMENT FEE TRACTOR TO CONNECT 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 BUILDING OR WORK ADDRESS_ SEPTIC TANK,SEEP,PITS) ' 1 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 REGULATING PLUMBING AND SEWERS. CESSPOOL. ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE D ISP OSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE PROPERTY. AS HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ .OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD SUPERVISING MECHANICAL ENGINEER CK. M.( CASH - t.� 1, 6 7 3 17 1 0 05.00- 4