HomeMy Public PortalAbout6359 BARELA AVE_Sewer__ 78A44213 APPLICATION-TOR PERMIT ],
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D 1 S POSA L
D.pm+sint of ConntT Eagta..e
ccmgy of z AnQ�l�s BUILDING
WM.J. FOX, COUNTY IENOIN[tl! ADDR[DS 3
CAGIDATT D. (3RIF7qN, SUPT OF XUILDIMG LOCALrTT I
FOR APPLICANT TO Fill IN NEAREST
CROaS ST.
LEGAL O
DESCRIPTION LOT NO. OWNER
BLOCK TRACT �l0 ' MAIL i
ADDRESS
H0. OF BLOGS.
SIZE OF LOT NOY OR LAT CITY r TEL NO.
UBE OF
BUILDINGS DISTRICT N0. GROUPI 5I YAP FG
CONTRACTOR $• Vega &- Sen^ Z5,ADDRESS N•7 1714 aBlvd COHIM=MN DATA
CITY • T". NN O. • STATION 7t DEPTH
92 79 6 46-4:2 [3 STATE MAN14OLLEE`REFERENCE LOWER
REGISTRATION?I0. 13 COUNTY'
TYPE OF CONNECTION LENGTH FROM 0
No. DESCRIPTION OF WORK F£E - P.L. Y.L.TO P.L
HOUSE SEWER CONNECTING TO
PUBLIOSEWER 9.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. 11 P.NO. JOS. NO.
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEiIER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
D13C0 NECT AND ABANDON 557WER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TI�NK,SEEPAGE PIT OR
PITS AHD/OR DRAINFIELD 2.00INDUSTRIAL
CEySPOOL-DRYWELL W E APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PMET CONNECTION CWGE FIE
0wNE'$ $ 1 00
AUTHORIZATION TOTAL FFA "FIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED.WITH THE HEREIN NAMED CON- APPROVAL$ DATE INDPEC70R�5 SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED DXI>1T1119 DWELJ_lNG
TO.THE PUBLIC SEWER -
SIGNED THIS 20 nAY OF %SSP 19tif� NEW HouGi SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS ADEN BUILDING OR WORK
SEPTIC TANK,BEEP,PIT(S)
ADDRFS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 AVE READ THIa APPLICATION CESSPOOL Q DRYWEU[3AND STATE THAT THD ABOVE 'S
C RECT AND AGREE TO COMPLY
WITH ALL COUNTY ON
RDINACES ND STATE LAWS REGULATING ALTER, REPAIR,S[WER OR
PLUMBING AND SEWER'. SEWAGE DISPOBAL SYIFT'EM
I HEREBT CERTIFY THA 1 PROPERLY A D/
LICENSED AS REQUIRED B ANGELES COUNTY A ST OF DIaCONNECT PLUG AND
CALIFORNIA OR THAT, 1 AM E LJIGAL,OWNER a VE ABANDON HOUSE DENIER
DESCRIBED REDIDEX BACKFILL SXMC TANK3❑ ��Iw
EIP FIT f C9"I.LO iV
DIGNATUR[ r
OF PERMr
WILLIAM J. FOX, Cou oLNi31t VALIDATION
��8 1 8 7 u; SEP 21 4 4.5 0 n
nr oY - -
DEPUTf %, DEPUTY
ST K
r;m DEPUTY DEPUTY
S&E-6D APPLICATION FOR PERMIT 5-88D�IVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER I NEAREST
ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
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 MAP
BUILDINGS BK PG
CONTRACTOR -
CONNECTION DATA
ADDRESS �-
STATION DEPTH
CITY TEL. NO. MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRATION NO. ❑ COUNTY - .--
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER a@ S-3—.50. Y. CURB P.L. M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR .-:„. _
PITS AND/OR DRAINFIELD @ $3,00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP.NO. 10B NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
LTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
EWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
NER'S PERMIT $ 00
REIMBURSEMENT FEE
RIZATION TOTAL,FEE
THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
LIC SEWER. NEW HOUSE SEWER
S DAY OF 19 CONNECT ADDITIONAL
BUILDING OR WORK _
NT SEPTIC TANK,SEEP,PITS)
AND/OR DRAINFIELD
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
NO SEWERS. SEWAGE DISPOSAL SYSTEM
CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
OR THAT I AM THE LEGAL OWNER OF THE ABOVE
SIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) ❑ CESSPOOLS❑
EE
BIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
CK. Y.0. CASH