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Home My Public Portal About4845 BALDWIN AVE_Sewer__ 6A64 2D,062 7APPLICATION FOR PERMIT 8A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Eng n B ADDRESS WILLIAM A JENSEN Sup t of Bu lcImg LOCALITY rDDNEAREST R PPLICANT TO FILL IN CROSS ST T IoO 11411 P OT NO IQ OWNER MAIL 41 TRACT � ADDRESS NO OF BLDGS LNOW ON LOT CITY TEL NO GS DISTRICTNO GROUP MAPPROCESSEDBY PG TOR BK 7"� CONNECTIOON DATA TEL NO ❑ ION PTH STATE MANHOLE REFERENCE IVI REGISTRATION NO COUNTY OWER NO DESCRIPTION OF WORK FEE TYP OF NECTION LENGTH FROM a HOUSE SEWER CONNECTING TO r �/ P L ML TO P Llet O PUBLIC SEWER @ S5 00 J! i 3L SEPTIC TANK SEEPAGE PIT OR /Vl JP C NO NO U CO IMP NO PITS AND/OR DRAINFIELD @ E1000 A �y � HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO 7 PRIVTE DISPOSAL SYSTEM @ $3 00 CONNECT DDITIONAL BLDG OR AFFIDAVIT RECORD INSTR NO DATE W WORK TO HOUSE SEWER @ S3 00 d OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ 55 00HWY OR ST WIDENING dD ��TV r1 ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO NDUSTRIAL WASTE AP ROVAL OWNERS PERMIT $ z 00 CHARGES AUTHORIZATION TOTAL FEE ,,,o CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO L C SEWER CONNECT THE ABOVE DESCRIBED EXISTING DWELL NG APPROVALS TO THE PU DATEn INSPECTO1 S SIGNA URGE SIGNED THIS DAY OF 19_ OWNER OR _ / NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) HEREBY ACKNOWLEDGE THAT I HAVEREAD 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 ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM C LIFORN IA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE ACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER L7+�o 7 1 j J _U j 1 :) D 700- 11 1�,�1t/cr,?,cII/ j 01 C,; 62 78A APPLICATION FOR PERMIT 8AG42D0 84 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / '- JOHN A LAMBIE County Eng ne ADDRESS (�J WILLIAM A JENSEN Sup t of Buildrng LOCALITY NEAREST F APPLICANT TO FILL IN CROSS S , �" DES I I T O OWNER , MAIL B T ADDRESS D / OF EI E L OW ON LOT 3 CITY TEL NO USE OF W�"� DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS �{BK PG CONTRACTORJV S Off' 17 Y T. Goy�r—L�o ADDRESS CONNECTION DATA CITY h TEL NO 1, GQ ION -I fiY " DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO ❑ COUNTY I zi0r A/ LOV♦kER NO DESCRIPTION OF WORK FEE ypE OF O TON LENGTH FROM d HOUSE SEWER CONNECTING TO Y P L M L TOP L '�- O PUBLIC SEWER @ $5 00 P C NO 0 SEPTIC TANK SEEPAGE PIT OR '2 PITS AND/OR DRAINFIELD @ $1000 CO IMP NO J JOB NOix HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO q FY8'7 o PRIVATE DISPOSAL SYSTEM @ $3 Do CONNECT ADDITIONAL BLDG OR AFFIDAVIT w RECORD INSTR NO DATE W WORK TO HOUSE SEWER @ $300 d OVERFLOW SEEPAGE PIT DRAINFIELD h EXTN CESSPOOL DRYWELL MANHOLE @ $500 Z ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT OA PERMIT NO NDU TRIAL / WASTE APPROVAL f CHARGES OWNERS PERMIT s o CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE Z S� I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE T ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBL C SEWER APPROVALS DATE INSP CTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR / NEW HOUSE SEWER OWNERS AGENT_�T�, CONNECT ADD T ONAL DDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD NO 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 DISPOSAL SYSTEM C LIFORNIA OR THAT I AM T E LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE ES RIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATIOI ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH f� 1 S O 44 5 1 1 D J