HomeMy Public PortalAbout5112 BALDWIN AVE_Sewer__ IL
PERMIT FOR CONNECTION TO MAIN TRUNK SEWER '
COUNTY SANITATION DISTRICTS OF LOS ANGELES COUNTY
Office of Chief Engineer and General Manager N? 9359
Telephone, EDg,"Wood 7-1025
� ^1
Los Angeles, Calif., 19 y
PERMISSION IS HEREBY GIVEN TO__ J'4' .- A A !! Q
(Owner) (Contractor)
to make sewer connection to the-- Q Trunk Sewer
in San. Dist. No. t6J between ``�+�• �' S�'
located at
Lot a� _____, Block Pr , Tract I CO;L
Location T,
SLIUULIII
10%4 6g) N 14)
a+ 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.
� M PTC N.
Sewer Plan No. � � Chief ngtneer and General Manager.
Inspected—______ —19 BY '
FORM NO.47 1-51 SM
D
S&E-663 11.55 APPLICATION FOR PERMIT 1
5&E-6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING //,Z if V
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �y Gf
®
CAS
SATT D. GRIFFIN, SUPT of BUILDING LOCALITYNEAREST
/T- � )�`�? �•� �
FOR APPLICANT TO FILL IN CROSS STLEGAL
y�, ��s�J Ur
DESCRIPTION LOT NO. OWNER /f'' �C[��c/J� S
MAIL
BLOCK TRACT / / ADDRESS
N0. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. N0.
USE OF DISTRICT NO. GROUP MAP
BUILDINGS BKR8�
CONTRACTOR T 1..
ADDRESS CONNECTION DATA
�SCs��/l �.Ti lGi�/�l� �✓e* .S
STATION $ j DEPTH
CITY`��- TEL. NO. ' !7 42
'r '
MANHOLE REFERENCE Y R
o `
9--STATE �!' — LOWER
REGISTRATION N0. 1 .R� ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CTION LENGTH FROM /
/ Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $,3.G0
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
I
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. / 3,1Z� JOB N0,
I HOUSE SEWER CONNECTING TO �� MI '��
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0. ,tOAD PERT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACH MrNw,"-,
WORK TO HOUSE SEWER @ $1.00 PERMIT N0. '
ALTER,REPAIR OR ABANDON HOUSE ItiDUSTRIAL ""' '
SEWER OR DISPOSAL SYSTEM @ $1.00 ITE APPROVAL
k - .CHARGES„_ -
y
Co NECTION CHAj:.GE$�e.r ++�
OWNER'S PERMIT $ 00
REI BURSEMENT FEE
AUTHORIZATION I TOTAL FEE 1 ,-r' e C2
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ A S DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
1
SIGNED THIS—DAY OF •�f�1= 19.4 CONNECT ADDITIONAL
OWNER OR / � ', BUILDING OR WORK
OWNERS AGENT �[ ,c �/�-C ✓' SEPTIC TANK,SEEP,PIT(S)
ADDRESSS��
7 "V
" - �3/'�J AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 — ------
DE::CRIBED RESIDENT[ ROPERTY. /' BACKFILL SEPTIC TANKS❑ P
��1.� SEEP.-PIT(S) ❑ CESSPOOLS
❑
SIGNATURE
OF PERMITTEE
JOHN A. LAMBIE• COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CASH
ACO 1 1 3 6`p DEC 2 10 A 5.0 0 M