HomeMy Public PortalAbout5032 BALDWIN AVE_Sewer__ PERMIT FOR CONNECTION TO MAIN TRUNK SEWER - :,,
COUNTY SANITATION DISTRICTS OF LOS ANGELES COUNTY r #�",` ""
Office of Chief Engineer and General Manager N° 8251
' con Telephone, EDgewood 7-1025
Los Angeles, Calif., �++ 19 rc
171440
PERMISSION IS HEREBY GIVEN TO
N ( ncr) .y. (Contractor)
to make sewer connection to the e► _ •�+. J Trunk Sewer
Wf�
win San. Dist. No. 1�between M, py'� Q & M.ut� C uae► lW
Q located at _,_j�
0 Lo _ , Block , Tract_ IV 2A
Location 'W T
WI
Pi Connection to Main Trunk Sewer shall be made in accordance with Drawings No. G-a-155, No. S-a-79 or
S-a-63. Gas trap in house connection shall be installed as per Dwg. No. S-a-71 and maintained at property
owners expense.
Sewer Plan No. 15—
!:p-l9 A M RAWN, Chief 'Engineer and General Manager.
Inspected 19 BY� k(,
FORM NO.47 1-51 SM
76P.C-663 3.55
8 APPLICATION FOR PERMIT - 0 3 V_ 1
8 E•66
DIVISION OF BUILDING AND SAFETY SEWER-SEW DISPOSAL
Department of County Engineer
County of Los Angeles TAIIIESS
LDING ,`
WM.J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING ALITYFOR APPLI NT TO FILL IN _NEAREST. ?
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL —� �j
ADDRESS cS ice/ (!
0. OF BLDGS, fA
SIZE OF LOT NOW ON LOT CITY NO.
USE OF
BUILDINGS DISTRICT NO. ROW
4 �3 MAP
BK PG
_ 1
CONTRACTOR 4 �,,, ,�-`, a y
ADDRESS ..;s ' 'jL ! Sf CONNECTION DATA
CITY TEL. NO. -..l' 4 �► STATION & � -f t1DEPTH ,
[ISTATE MANHOLE REFERENCE PER
REGISTRATION N0. 1 � �' f% d�'❑ COUNTY -_
NO. DESCRIPTION O WORK FEE
T'iP 'ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO CURB ®. M.L_TO P.L.
PUBLIC SEWER @ $ 3.50 -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 -
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 _CO. IMP. NO. JOB_ N0.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO��+
ZT, ROAD PERMIT NO.
I DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
j AND/OR DISPOSAL SYSTEM 1.00 _ PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR --
PITS AND/OR DRAINFIELD •00 -INDUSTRIAL
CESSPOOL- DRYWELL
WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00
OWNERS PERMIT $ 00 C ARGE FEE
AUTF€ORIZATION TOTAL FEE I � `1 REIMBURSEMENT FEEr,,,�
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING' DATE INSPECTOR'S SIGNAt' RE
TO THE PUBLIC SEINER - y /
SIGNED THIS _DAY OF 19- EW AV E SEWER
OWNER A/l NNECT ADDITION
OWNERS AGENT ✓ / ILDING
S C TANK,SEEP, PIT(S)
ADDRESS _ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEINER.
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
3 SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J.F .COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
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