HomeMy Public PortalAbout5232 BARELA AVE_Sewer__ 76A 64//zlL'( EB08 A-7/76 APPLICATION FOR PERMIT
SEW..ER—SEWAGE DISPOSAL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN DISTRICT NO- GROUP MAP PROCESSED
BY
BK FG
[NEAREST
ILDING
DRESS 4
I�(1y CONNECTION DATA
LOCALITY r( STATION DEPTHOSS ST. L
y
MANHOLE REFERENCE LIPPE/" � .: LOWER
OWNER " „ ,S TYPE OF CONNECTION LENGTH FROM
MAIL4E!_ Y. CURB P,
L. M.L.TO P.L. 13
ADDRESS
n (� f �/ P.C.NO.
CITY •TEL. N0. °//�S 7` /�/S CO.IMP.NO. JOB NO.
LEGAL TRUNK PERMIT NO. ROAD PERMI NO.
DESCRIPTION LOT NO.
�9� AFFIDAVIT WAItlEE EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT
/� NO. OF BLDGS.
SIZE OF LOT (.� NOW ON LOT HWY.OR ST.WIDENING
USE OF STATE ENCROACHMENT -
BUILDINGS E
PERMIT NO.
INDUSTRIAL
CONTRACTOR �., l ;jam r_: WASTE APPROVAL
ADDRESS ;� c-e__ CHARGES
•� y CONNECTION CHARGE FEE
CITY TEL. NO. r J 2
STATE LIC /` REIMB C/�/�
LICENSE NO:_ O C OZ- CLABS &6 / F"
NO. I DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE
HOUSE SEWER CONNECTING TO /•' VNE
r �, CL
PUBLIC SEWER �jSEWERSEPTIC (ANK.SEEPAGE PIT ORPITS AND/OR DRAINFIELD C� DITIONAL
HOUSESEWER CONNECTING TO R WORK
PRIVATE DISPOSAL SYSTEM ,SEEP,PITS)
CONNECT ADDITIONAL BLDG.OR I NFIELD
WORK TO HOUSE SEWEROVERFLOW SEEPAGE PIT.DRAINFIELD DR-YW ELL ❑
EXTN..CESSPOOL.DRYWELL,MANHOLE @ -
ALTER.REPAIR OR ABANDON HOUSE ALTER,REPAIR.SEWER OR
SEWER OR DISPOSAL SYSTEM @ SEWAGE DISPOSAL SYSTEM
DISCONNECT'PLUG AND
ABANDON HOUSE SEWER
ON-
BACKFILL SEPTIC TANKS ❑
SEEP.PIT(S) ❑ CESSPOOLS ❑
OWNER'S Issuance Fee
ICATION
AUTHORIZATION TOTAL FEE 0�
RE
AND STATE THAT EREBY ACKNOWLEDGE
EABOVEHIST CORRECT AND AGREE I HAVE READ THIS ATOLCOMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- PLUMBING AND SEWERS.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT 1 AM PROPERLY.REGISTERED AND/OR
TO THE PUBLIC SEWER. r_ - �� LICENSED AS REQUIRE BY LOS ANGLES COUNTY AND STATE OF
SIGNED THIS DAY OF 1`J_ CALIFORNIA OR T I A� THE LEGAL OWNER OF, AND INTEND TO
OWNER OR 1 RESIDE IN, THE BOVE ESCRIBED RESIDE PROPERTY. e
OWNERS AGEN ` - SIGNATURE
OF PER M TiTEE ��
kLID-' C
CK, M.O. CASH
893r--SEf "'niU U 1 5L0 ��'G
i c
76A 642iE808 A-7/76 APPLICATION FOR PERMIT
y
-SEWER—SEWAGE DISPOSAL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
BUILDING FOR APPLICANT TO FILL IN ollcT GROUP BK PROCESSED BY:BY
ADD RIESS 5 Z 3Z 'O (�
'r CONNECTION DATA
LOCALITY �� e� �—
NEAREST _ STATION -7`?- DEPTH ,
CROSS ST. v L�
r\
D I MANHOLE REFERENCE r��, ! d
OWNER `Q v TYPE OF CONNECTION LENGTH FROM
MAIL /'I Y. CURB P.L. M.L.TO P.L.
ADDRESS C2,
P.C.NO.
CO.IMP.NO. JOB NO,
CITY TEL. NO.
LEGAL TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO.
AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF STATE ENCROACHMENT
BUILDINGS PERMIT NO.
INDUSTRIAL
CONTRACTOR ® 1
WASTE APPROVAL
ADDRESS (:---ICHARGES
V
• CONNECTION CHARGE FEE
CITY TEL. NO. /�'/ �j ,,,///��I
STATE 0 Z�. LIC �,r� RE1MB11GIFFE6� `' � {�'�/., �'J
LICENSE' GLASS �J I
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE W
HOUSE SEWER CONNECTING TO /�I O.
PUBLIC SEWER @ / / / N
SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWER J Z
PITS AND/OR DRAINFIELD @ CONNECT ADDITIONAL
HOUSE SEWER ONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM @ SEPTIC TANK.SEEP,PIT(S)
CONNECT ADDITIONAL BLDG,OR AND/OR DRAINFIELD
WORK TO HOUSE SEWER @ /
OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL ElDRYWELL Elf^� �r
EXTN..CESS POOL.DRYWELL.MANHOLE
ALTER.REPAIR OR ABANDON HOUSE ALTER,REPAIR,SEWER OR
SEWER OR DISPOSAL SYSTEM @ I
SEWAGE DISPOSAL SYSTEM
.I DISCONNECTPLUG AND
ABANDON HoUSESEWER
BACKFILL SEPTIC TANKS ❑
SEEP.PIT(S) ElCESSPOOLS ❑
OWNER'S Issuance Fee
AUTHORIZATION TOTAL FEE �q I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS j
C.d AND STATE THAT THE ABOVE IS CORRECT AND AGREEY
WITH ALL COUNTY ORDINANCES AND STATE LAWS
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- PLUMBING AND SEWERS.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT I AM PROPERLY_REGISTERTO THE PUBLIC SEWER. C LICENSED AS REQUIRED BY LOS ANGLES COUNTY ANFSIGNED THIS DAY OF CALIFORNIA OR THAT THE LEGAL OWNER OF, ANOWNER OR RESIDE IN, THE ABO E ESCRIBED R IDE L PROP
OWNERS AGEN r Fm A � SIGNATURE
OF PERMITTEE Jj
�ALM.D.CK ,O. CASH
892-E-SEP 16 11 0 3 0.0 0 %► .��