HomeMy Public PortalAbout6403 BARELA AVE_Sewer__ 2" INSEM
APPLICA IO
7M�41n N FOR PERMIT
COUNTT OF LOS ANGELES
SEWEEWAGE DISPOSAL
DEPAflTMIUff OF COUNTY ENCS
BUnd)MG AND. HAFETY DIVISION UILDING
ADDRESS
LOCALITT '
NEAREST
FOR APPLICANT TO FILL IN cRo>!s ST
F31ZE
EGAL
RIPTION LOT NO. OWNER '
K TRACT MAIL
ADDRESS Ol �
X0.OF BLD GD.
OF LAT XOW ON LOT CITT —1901� TEL MO. 114
UDE OF DISTRICT M0. GADUP YAP PROCEddKD DT
BUILDINGS
Dl PG
CONTRACTOR
ADDRESSCONNECTION DATA
CITT TEL 140. re,7 I STATION DtPre
STATE MANHOLE REFER" UPPER
Rge1STRATIO n0. 7 COUNTT
No. HH DSS SEW CONNECTING
R FEE
PUBLIESEWER�CONNECTING TO
EW TTPE OF COXXECTIOn LENGTH FROM
SEPTIC TI(XK,SEEPAGE PIT OR �'. CURB P.L ■.L TO t
PITS AND/OR DRAIXFIELD
OVERFLOW SEEPAGE PIT DRAINFIELD
EM C POO DR
Mo.
HO SE SEWER C'NL U I GTO CO.IMF.NO. JOB X0.
1 DIppPppOIITT ppL ��{I,,
WORKOQ
COXNETO HOLI3EIS,WR LDG.OR TRUNK PERMIT NO. ROAD PERMIT N0.
A R, N HOUSE 00 �� STATE ENCRDAC XT
PERMIT N0,
INDUSTpd
W PPROYA
CHARGED
OWNS PmW FU CONNECTION CHARGE F
AUTHOEPLATION TOTAL FSE i REI■BURSE■ENT FFJS
AATORTCINCTYE WITH BEDII �ELJTRCTOo THIS
TRAOYDEESCRIEZISTNGLN4 APPEOVALS DATY INSPECTOR'S SIGNATURK
TO THE PUBLIC SEWML
SIGNED THIS SAY OF 19— NEW HOUSE SEWKR
OWNER OR NERS AGE1fT CONNECT ADDITIONAL /
BUILDING OR WORK 1
ADDRESS SEPTIC TANK,SEEP.PITS)
AX R DRAINFIi1D
1 HEREAT ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE ID CORREOT AND AGREE TO COMPI_T CESSPOOL DRTWEL
WITH ALL COUNTT ORD] CES AND STATK LA GULATIXG ALTER,REPAIR,$EWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HERE BT CERT[ T 1 AM LT REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS
REO BT LOS XGE C XTT AND STATE F ABANDON HOUSE SEWER
CALIFORNIA OR 1 AM TH LEG 0 XU THE
DESCRIBED E SAL PROP BACKFILL BE C TANKS
SIGNATU DEEP.PIT S CESSPOOLS
OF I
Or TIO ROBERT A. WOOD
L 0. US[ IUPiFtYIalNO NKCHAPIIC.AJ.,KNOINi3Cft
LAL,O7 6 7 5kz� x0v30 1 0 D 5.00 �'
"""= APPLICATION: FOR PERMIT ],
K-681 IVISION OF BUILDING AND SAFETY SEWER—SEWAGE D I S POSA L
BUILDING
WM.J. FOX, COUNTY ENGINRJER AJ)DREEa
CASSA7T D.GRIMM,Sup-T OF WuiLDIMo LOCALITY
FOR APPLICANT' TO FILL IN NEAREST
cRoe3 3T.
LEGAL
DESCRIPTION LOT NO. OWNER
etOCC TRACt' ( tir X ,O RAIL
%DDRESS
N0. OF BLDGS.
SIZE OF LOT X I NOW OX LOT CITY TEL 140.
USE OF
BUILDINGS DISTRICT NO. GROUP I YAP
CONTRACTOR BE PQl
i
ADDRESS COMP TION DATA
CITE L NO. A;fiaj STATION �2 ' Q). DEPTH
❑ SLATE 1 "ll
UPPER REFERENCE
REGISTRATION
N0. ❑ COUNTY
A�—Af� TYPE OF CONNYCTI LENGTR FROM
No. DESCRIPTION OF WORK FEE. T CURB gfF L Y.L.TO P.L.
OUSE SEWER CONNECTING TO
PUBLIC SEWER 0 1 3.30
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL'SYBTEM 1.00
p CONNECT ADDITIONAL BLDG. OR CO. INP.1110. 1i'• JOB. NO.
WORK TO HOUSE SEWER 1.00
ALTER OR-REPAIR EXISTING
3EW OR•DISPOBAL SYSTEM _ 1.00 �RUNK PERMIT p0. ROAD PERMIT r0.
DISCONNECT AND ABANDOII SEWER STATE ENCROACHY
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
��ES�POOL-DRYWELL WASTE APPROVAL
JPHCIAL-CONDITIOXS ONLY 2.00 CHARD
'CONNECTION CHARGE FEE
��OWNEE'S �T s 1 00 '
A MORMTION -TQTAL FEE �/4 REIMBURSEMENT FEE1 HAVE _ -
MED CON-
TRACTORTHIS DATE TO CONNECT CONTRACTED
ABOVEWITH
DES 7 E HER IN BED CKX TINQADFEI,LING APPEOVAIS DA IN OR'a SIGNATUPE
TO THE PUBLIC SEW ,,t..
SIGNED THIS-� .�—DAY OF bF } N¢rrlloua[SEWER
OIRN<<R - OR XNECT�ADDITIOXAL
OWNERS AGENTUILDIXG OR WORK
SEI'"! C TAN[,SEEP,PITY)
ADDRES AND�OR DRAINFIELD
1 HEREBY ACKNOWLEDGE TRAT 1 HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL[IAND STATE THAT THY ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDIItANCK AND STATE LAWS REGULATING ALTER.REPAIR,SEW IR OR _
PLUMBING AHD SEWERS. t SEWAGE DISPOSAL SYSTEM '
1 HEREBY TTIFY THAT 1 AM PROPERLY REGISTERED AHD/OR
LICENSED AS k2QUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALWORNIA OR THAT 1 AY THE LEGAL OWNI! OF THY ABOVE ABANDON HOUSE SEWER
D[SCRIB D RUSIDEII Kay. - BACKFILL SKPTIC TANK❑
aE>zP.PI'D s csasro - �
SIGNATURE ��Arc
OF M.—MI
VILLLAM J. FO COUNTY iNalmum VALIDATION
IU 7 5 2 5 'SEP 6 4 550,
ST SY
DEPUTY ell
DEPUTY
BY ST
m D EP UTY DEPUTY