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Home My Public Portal About5430 BALDWIN AVE_Sewer__ S&E 663 12 54 APPLICATION li DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of LOS Angoles BUILDING it Al /1/ J>/i),ri/ WM J FOX COUNTY ENGINEER ADDRESS V /�LDUJ /1/ CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY �'� �� FOR APPLICANT TO FILL IN NEAREST CROSS ST LEGAL DESCRIPT ON�' LUNO --"7 ��J / OWNER �'�� G 0 v GSI BLOCK TRACT « MAIL 7� v ADDRESS A 1 NO OF BLDGS SIZE OF LOT Fio NOW ON LOT r CITY — C T- EL NO USE OF �J BUILDINGS -0 a.C�f` G:-(,L tc. DISTRICT NO GROUP MAP PG BK CONTRACTOR I r Te— 14--2 wo - ADDRESS CONNECTION DATA CITY TEL NO STATION DEPTH ❑ STATE (MANHOLE REFERENCE REGISTRATION NO ❑ COUNTY =`� UPPER LOWER TYPE OF CONNECTION LENGTH FROM NO DESCRIPTION OF WORK FEE Y CURB P L M L TO P L t HOUSE SEWER CONNECTING TO _ PUBLIC SEWER Q $ 3 50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO WORK TO HOUSE SEWER 1 00 Al TER OR REPAIR EXISTING —S EWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL DRYWELL WASTE APPPOVAL SPECIAL CONDITIONS ONLY 2 00 4 CHARGES r �j�+ //f OWNERS PERMIT $ 1 00 CONNECTION CHARGE FEE�� /J ��6�a/ 0) AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE THIS DATE CONTPACTED WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER SIGNED THIS AY 0 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGBUILDING OR WORK SEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I 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 ALTER REPAIR SEWER OR PLUMBING AND SEWERS _ _SENAGE DISPOSAL SYSTEM IHEREBY 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 RESIDENTIA OPERTY BACKFILL SEPTIC TANKS❑ SEEP PITS) ❑ CESSPOOLS❑ SIGNATURE OF PERMITTEE w, WILLIAM J FOX COUNTY ENGINEER VALIDATION BY 124 � ,5 ' - 1 39 6000a4Y < DEPUTY DEPUTY BY BY ® DEPUTY DEPUTY D 5&E 6e3 t254 APPLICATION FOR PERMIT 1 DMSION OF BUrLDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Eagmeer County of OU TY EN 8 'BUILDING WM J FOX COUNTY ENGINEER CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY�f�i FOR APPLICANT TO TO FILL IN CR0SS ST ,/�Ae to C/ ,J f�7 LEGAL0 —DESCRIPTION L 0 T N ,./t/'/�-�tl ��9.��'�I OWNER BLOCK TRACT q A IDRESS NO OFBLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF f BUILDINGS DISTRICT NO GROUP CONTRACTOR ] A r ADDRES , CONNECTION DATA l CITY � TEL NO '',� STATION DEPTH � � ❑95IATE MANHOLE REFERENCE REGISTRATION NO ❑ COUNTY UPPER LOWER ' TYPE OF CONNECTION LENGTH FROM NO DESCRIPTION OF WORK FEE Y CURB P L M L TO P L HOUSE SEWER CONNECTING TO � �T QGavfed j ,� r1 PUBLIC SEWER @ $ 3 50 fi HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 r OF CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO ALTER OR REPAIR EXISTING iy�� _ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO `j 1 ROAD PERMIT NO ��0 DISCONNECT AND ABANDON SEWER —� AND/OR DISPOSAL SYSTEM 100 STATE ENCROACHMENT PERMIT NO SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNER S PERMIT 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS A�- I SP CTOft S,SIGNATU ZE TO THE PUBLIC SEWER /) SIGNED THIS D Y r �+� 19 NE Hou q(�� I�I'++�V,p;J cs-,r�jTj _pyo OWNER OR CO BUI DINT R 6IiiA�AvGtl t�dtl t� 0 ❑ OWNERS AGEN SEP IC TANK SEEP PITS) ADDRESS OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CE 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 IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ I�f � � , SEEP PIT(S) ❑ CESSPOOLS❑ �� ///� SIGNATURE ` OF PERMITTEE - v (p WILLIAM J FOX,COUNTY ENGINEER VALIDATION ° TO-27225 APR18 4 450 ID BY 7 BY _ /}J/ 1 (� DEPUTY EY Lz_- 4 .vl(//� P BY BY /� 0 DEPUTY DEPUTY