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HomeMy Public PortalAbout6027 BALDWIN AVE_Sewer__ ,0-69 76A642D APPLICATION FOR PER 6A64I J 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 NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. ZQ Z OWNER L7 MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROC SED BY BUILDINGS [[�� Lj BK PG CONTRALTO 1 l _ ADDRESS 7 V UUU FFF---✓✓✓ C NNECTION DATA CITY / TEL. NO.C4�^�' [ � STATION "9 Q DEPTH /© le STATE 'MANHOLE REFERENCE t 1� REGISTRATION NO. �. ❑ COUNTY OWER NO. 1 DESCRIPTION OF WORK EE TYPE F NNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y P.L. M.L.TO P.L. Z�� PUBLIC SEWER @ $5.00 IL SEPTIC TANK.SEEPAGE PIT OR / P.C.NO. O IMPNOCO.. . . /(J JOB NO. V PITS AND/OR DRAINFIELD @ 510.00 /� �7 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. y�� �( w PRIVATE DISPOSAL SYSTEM @ $3.00 ,I C./ 0 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE �... WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT,DRAINFIELD LLL EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 r h ALTER. EPAIR OR ABANDON HOUSE R E IN Z EWE OR DISPOSAL SYSTEM @ $3.00 S A ENCR C ER IT NO. INDUSTRIAL WASTE APPROV CH ES OWNERS PERMIT $ 2 AUTHORIZATION TOTAL FEE .sf CONNE T H F Q 'I HAVE 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 WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS.. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS 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 VE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE eZ BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER i.r'Evo 4 9 4 3 GCT 16 : 2 D 2 5.0 0— �' kms•• o-6a 76A642D _ APPLICATION FOR PERMI 6A642 ' u COUNTY .OF LOS ANGELESSEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING a JOHN A.,LAMBIE.. County Engineer ADDRESS WILLIAM A. JENSEN. Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN `':•. CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER i{ MAIL BLOCK TRACT ADDRESS NO. ,OF SLOGS. SIZE OF .LOT NOW ON LOT CITY TEL. NO. U5E OF DISTRICT NO. GROUP MAP PROCES BY BUILDINGS SK PG CONTRACTOR ADDREsS v CONNECTION-DATA CITY TEL. NO4• O STATION �7 DEPTH�O r REGISTRATION NO. C COUNTY. MATATE NHOLE REFERENCE .0/ LOWE NO. DESCRIPTION OF WORK EE , 'TYPE F' NECTION LENGTH FROM " / HOUSE SEWER CONNECTING TO - P.L. M.L.TO P.L. PUBLIC SEWER 55.00 O SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD 510.00 CO:IMP.NO. JOB NO. O V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 fY CONNECT ADDITIONAL BLDG.OR AV R E D T WORK TO HOUSE SEWER 0 $8.00 OJ U OVERFLOW SEEPAGE PIT,DRAINFIELD 149W EXTN.,CESSPOOL,DRYWELL.MANHOLE 0 S5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR E h SEWER OR DISPO AL SYSTEM 58.00 STATE ENCROACHMENT i:iz 404 Z PERMIT N . INDUST L WAST V CHARGES OWNER'S MIT s 2 00 AUTHORIZATION T TAL FEE ..CONNECTION CHARGE FEE •1 RAVE 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 SIGNATUREI SIGNED THIS DAY OF 1.9_, _ , �ipe�• �sz r i OWNER OR .NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL / ' W BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(5) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD 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 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A VE DESCRIBED RESIDENTIAL PROPER Y. ABANDON HOUSE SEWER SIGNATURE• BACKFILL.SEPTIC TANKS ❑ OF PERMITTE SEEP,PIT(S) ❑ CESSPOOLS ❑ VM.0.ALIDATION ROBERT A. WOOD CK. SUPERVISING MECHANICAL ENGINEER. CASH LACO 4 9 4 2 OCT 16 1 0 D 7.00— a APPLICATION PERMIT S&E•663 3-56 K DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Dep=tment of County Engineer County of Los Angeles BUILDING , WM.J. FOX, COUNTY ENGINEER ADDRESS ® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY-;: FOR APPLICANT TO FILL IN NEAREST CROSS ST., LEGAL DESCRIPTION LOT NO. OWNS"";- ! BLOCK TRACT MAIL 7 ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT - CITY TEL. NO. USE OF 7 BUILDINGS DISTRICT NO. GROUP MAP CONTRACTOR '- -r I BK PG r ADDRESS,,,*i,. el ,^;:t CONNECTION DATA TEL. NO. r x"' STATION -- f- - 2{' DEPTH ' P--STATE MANHOLE REFERENCE _ EE9R REGISTRATION NO. 4f' r.,�" ❑ COUNTY .+' LOWER No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF,.GpNNECTION LENGTH FROM PUBLIC SEWER @ $ 3.50 : Y. t'tI1Rgg'� P L M L TO P.L. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. ORP. C. NO. WORK TO HOUSE SEWER 1.00 CO. IMP. NO. -r' - JOB N0. ti ALTER OR REPAIR EXISTING i SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 STATE ENCROACHMENT - PERMIT NO. I SEPTIC TANK, SEEPAGE PIT OR PITS_AND/OR DRAINFIELD 4.00 INDUSTRIAL CESSPOOL-DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES � 00 OWNER'S PERMIT CONNECTION CHARGE FEE $ AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN KAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS _DAY OF 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGE MZ d' BUILDING OR WORK SEPTIC 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 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY,,— BACKFILL SEPTIC TANKS❑ SEEP. PIT(S) ❑ CESSPOOLS❑ SIGNATURE orf ` r OF PERMITTEE f"~ WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR D S&E-663 3.55 APPLICATION FOR PERMIT 5&E-6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL V Deportment of County Engineer County of Los Angeles 7�DRESS WM.J. FOX. COUNTY ENGINEER (7) CASSATT D. GRIFFIN, SUPT OF BUILDING - FOR APPLICANT TO FILL IN CROSS ST. 1• LEGAL DESCRIPTION LOT NO. -• OWNER - - BLOCK TRACT >;, f'' MAIL . t ADDRESS NO. OF BLDGS. LOT NOW ON LOT CITY i ;-TEL. NO. .p� OF , [BUILDINGS F �Y�i DISTRICT NO. GROUP MAP •^ •T Fes. I BK PG CONTRACTOR — ADDRESS CONNECTION DATA CITY ,•_:. ' .TEL. NO. ty r- ,�• - STATION DEPTH ❑ STATE MANHO REFERENCE ER REGISTRATION NO. El COUNTY OWER No. DESCRIPTION OF WORK FEE TYPE O ONNECTION LENGTH F HOUSE SEWER CONNECTING TO Y. CU P.L. M.L. T .L. PUBLIC SEWER $ 3.50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 _ CONNECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOB NO. + ALTER OR REPAIR EXISTING TRUNK PERMIT N0. ROAD PERMIT NO. 1 SEWER OR DISPOSAL SYSTEM 7.00 DISCONNECT AND ABANDON SEWER STATE ENCROACHMEN AND/OR DISPOSAL SYSTEM 1.00 4 PERMIT NO. I SEPTIC TANK,SEEPAGE PIT OR - INDUSTRIAL ! CESSPOOL- DRYWELL WASTE APPROV SPECIAL CONDITIONS ONLY 2.00 _ CHARGES OWNER'S PERMIT1 00 CONN TION CHARGE FEE S AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTORHAVE TTOS CONNECT THE AABOVECTED WDESCR BED EXISTINGITH THE HEREIN A DWELLING ED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF t. 19_T NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING 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. ALTERDISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE 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 SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP. PIT(S) ❑ CESSPOOLS❑ SIGNATURE OF PERMITTEE WILLIAM J.FOX,COUNTY(ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR 77. -,.a D S&E-669 f 1.55 APPLICATION FOR PERMIT S d E-8 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS T) CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL OWNER DESCRIPTION LOT NO. - MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. CITY TEL. NO. SIZE OF LOT NOW ON LOT USE OF DISTRICT NO. GROUP I MAP BUILDINGS 8K PG CONTRACTOR CONNECTION DATA ADDRESS - P-- - - STATION DEPTH CITY TEL. NO. UPPER MANHOLE REFERENCE _ ❑ STATE LOWER REGISTRATION NO. ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $3.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAG RAINFIELD P.C. NO. EXTN„CESSPOO RYWEL MANHOLE @ $2.00 / CO. IMP. NO. JOB NO. HOUSE SEWER C G TO t PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT i WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMT $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE t,1, I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) LDRES AND/OR DRAINFIELD EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR NG AND SEWERS. SEWAGE DISPOSAL SYSTEM EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER RNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ED RESIDENT+AL PROPERTY, BACKFILL SEPTIC TANKS❑URE SEEP.PIT(S) ❑ CESSPOOLS❑ RMITTEE JOHN A. LAMBIE,COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR CK. Y.0, CASH 7GA642DAPPLICATION FOR PERMIT5 & S E-66-663 3.55 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L Department of County Engineer 11 County of Los Angeles BUILDING .- 1 ✓' - WM.J. FOX, COUNTY ENGINEER ADDRESS ® CASSATT 0.GRIFFIN, SUPT OF BUILDING LOCALITY"•'_ - FOR APPLICANT TO FILL IN NEAR sr. g . - - LEGAL DESCRIPTION LOT NO. & OWNER BLOCK TRACT MAIL - ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS t '�- {r' }`•' _ DISTRICT NO. I GROBK UP MAP PG CONTRACTOR/,"' ,r .. ADDRESd ,! s f: r ,, CONNECTION DATA , a STATION TEL. NO. " - DEPTH , "STATE MANHOLE REFERENCE ., ga UPPER REGISTRATION NO. F st y COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM ,.G„ PUBLIC SEWER @ $ 3.50 f Y•V' CURB P.L. M.L. TO P.L. HOUSE SEWER CONNECTING TO t r 1fr^ ;,�, �:� y�-� y.. PRIVATE DISPOSAL SYSTEM 1.00 -�r>t � - CONNECT ADDITIONAL BLDG.OR _ P. C. NO. WORK TO HOUSE SEWER 1.00 CO.OIMP. NO., f JOB NO. ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N Jt1,, i DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT { I. AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. I SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD .00 INDUSTRIAL CESSPOOL-DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES a 1 00 OWNER'S PERMIT CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTORHAVE TTOS CONNECT THEDATE AABOVE DESCRIBED EX STINGCTED WITH THE HEREIN A DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS -DAY OF 19 NEW HOUSE SEWER OWNER OR - CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK } ���,;��,,, SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[3AND 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 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND i; CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER - DESCRIBED RESIDENTIAL PROPERTY. fry^ BACKFILL SEPTIC TANKS❑ i •� SEEP. PIT(S) ElCESSPOOLS El SIGNATURE `` .✓ OF PERMITTEE WILLIAM J.FOX, COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF FLBG. INSPECTOR