HomeMy Public PortalAbout5927 BARTLETT AVE_Sewer__ APPLICATION :F �t PERMIT
DIMON OF MING AND SAFETY S EWPER—SEWAGE D 1 S POSA L
commly of Los � 19UILDIPIG �
WAL J. FOX, COUNTY EENaINtiR ADDRESi
- C.,11ATT D.aRIMM,4W?F T OF■Ur Drn,G LOCAUTT `
FOS APMCANt TO FILL eEAREat
CII SL ST �
1JSGAL
DES CR OR LOT N0. OWRIM
BLOC[ TRACT S AMAIL
DDR
y, DDR Lam/
SIZE OK LOT of v XON OX LOTS
crrY TEL. N —J
USE OF
BUiLDINGs � �� DISTRICT 1{0._ GROUP I �x MAP G
CON71 ACTQR , ✓hT _ �r
AODRESS CONM=ON DATA
CITTZM9k&&Z
/ TEL N)O ?i/ STATIONXL DEPTH
EXATEREGISTRATION No � � O � ,J� � COUNTY " HOLE REFERENCE ER
E QF RECTION 'LENGTH FROM
N0. -DESCRIPTION OF WORK FEE T RB 1,L. Y.L.TO P.L.
•HOUSE SEWER.CONNECTING TO ^
PUBLIC SEWER or 3.50
HOUSE SEWER CONNECTING TO
. PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL 6LDG. OR CO. IIP.N0, JOB.NO.
WORK TOHOUSE SEWER 1.00
ALTER OR REPAIR EXISTING ,TRUNK PERMIT 110. ROAD PERMIT 110
SEISE�I OR DISPOSAL SYSTEM 1.00 O. /
RISCONNFCT AND ABANDON SEWER GTATE ENCIIOAtHYENT
AXD/OR ISPOSAL SYSTEM 1.00 FER IT 110.
SEPTJC Tl(XK,SEEPAGE PIT OR
PITS AND/OR D IXF16Lb 2.00 tRDUSTRCAL
CESSPOQt-DRYWELJ. WASTE APPROVAL
PECHIL CONDITIONS ONLY 2.00 CHARGES
CORRECTION CHARGE FEE
OWIers PEUM f 1 00
TOTAL FEE RE14BURSENERT FEE
2iUTSOBI7.PlTIOi1
1 HA CHIS DATE CONTRACTED WLTH THE HEREIN NAYI=D COX- *i a DA7� INSPECTOR'S 6IGXATUk�
TRACTOR 70 CONNECT THE ABOVE DESCRIBED EKI$TIRG DNQLLINQ APPSOVXI$
TO THE PUBLIC SBA REW HOUSE SEW-Eit
SIGNEIj THI DAY-C ` ;olcb
L CONNECTADDLTIOXAL
OWAEk OR+ ((/(f-�77 BUILDING OR WORK
DW HERB ADEN
SEPTIC TANK, SE PIT(S)
ADDR ARD OR
DRANFI L.b
I HEREBY Il��CKNOWLEDGE THAT 1 RAVE REND THIS APPLICATION CEJSSPOOL❑ DRYWELLD
AND STATJ TFlAT THE ABOVE IN CORREV AND AGREE TO CPM PLY
WITH ALL COUNTY ORDINANCES AXD STATE LAWS REQULATING ALTER,PLUMBING AND 5i"WTRS. SEWAGEOY
1 HEREBY CBjTIPT THAT I AN PROPkRLY RRGISTERED AND/OR
LIGEMSED AS REQUIRED BY LOS ANGELEQ COUNTY "D STATE OF DISCONNECT PLUG AND
DC{ALLII OR IA OR THAT 1 AY THELJtQkL OWNER OF THE ABOVK ABANDON HOUSE SEWER
DES"IB�D RISIQENTIAL PROPERTY. ' BACKFILL
SIGMA'URE -
OF PERMITTEE r
LLIATI J. FOX.COUNTY 1'allommt YAI•Q?XTIOZf
(1T.1Liam +F 8 2 u�i 8 4 4-50 to DEPUTY
YST - BY
,•� DEPUTY DEPUTY
C[ E
7eA.AB43LD APPLICATION FOR PERMIT
eun I-I
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRw
COLEMAN W JENKINS. SUPT. OF BUILDING
LOCALffY
M[A R EST
FOR A PUCANT TO FILL IN `ROSS-/T
LEOAL
DESCRIPTION LOT NO. OWNER VQ
vJ ��
BLOCK ,���, TRACT ADD ADDRESS C
NO. OF BDG■.
SIZE OF LOT NOW OHLLOT CITY TR NO.
U/[ DI ICT N0. GROU MAP PROCESSD BY
■UILDINO/ E//77
CONTIU,CT OR ` �' C2—
ADDRESS C.OPMCnON DATA
CITY .� Q � HO. �j STATION DEPTH
LIC[NS[ N.� I�r�/, LIQ-N/SI G) MA HH OLE REFERENCE 1 URiR
LOWER
No. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
GUS[SEWER CONNECTIOO TO Y. CURE F.L M.L TO P.L
PUSLIC/EWER 0 SS. P,C.NO. O
B[FTIGTANK.B[ O[PIT OR CO.IMF.NO. JO■NO.
PITS AND/OR DRAINFIELD 0 510.00 U
HOUR[S[W[R CON N[CTING TO TRUNK P"MIT NO. ROAD P[RMfT NO. p(
PRIVATE DISPOSAL SYSTEM 0 $7.00 O
CONNECT ADDITIONAL■ .IM AFFIDAVIT EAtY[l wnoT RECORD.IN NO. DATE
O HOUSE S[W[R 0 57.00
OVERFLOW B[@AOE F(T.DRAINFI[LO
E%T N..CES/PO OLY
DRWELLMANHOL46 $5.00 n'
ALTER.REPAIR OR ASA ON lHoust HWY. OR ST.WIDENING Z
/EWER OR DI POSAL M $3.00 STATE[NCROACHM4fT
TN 0.
N0.
INDUSTRIAL
WAST[APFROVAt
O_nw�mrs PERMT s 2 OO CHAkG
�
AUTHOFMATIONI TOPU FM CONNECTION CHARGE FI[
I HAVE AT THIS DAT[ A CONTRACT WITH THE HER NAMED CON- R[IMBURSEM[NT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED L%ISTINO DWELL
IN +_
TO THE PGv
UBLIC SEWER. DAT[ IN/P[CTOR'/SIGNATURE
SIGNED THIS DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENT COHN[QT ADDITIONAL
ADORE." BUILDING OR WORK
STANK.SERF,PIT(/)
I HERESY ACKNOWLEDGE L[DO[ THAT I HA VI READ THIS APPLICATION AND/OR Dl1AINFIE1[LD
AND /TAT[ TH T THE ABQVE IS CORRECT AND AOR[[ Tb COMPLY'
WITH ALL CO�NTY ORDINANCES AND STATE LAWS REGULATING
FLU Mp IND AND SEWERS. CXBSPQOL Q DRYWELL ❑
I HEREBY CERTIFY THAT I AFI PROPEAI.Y REGISTERED AND/OR ALTER,REPAIR.S[W[R OR
LI
C[NS[D AS REQUIRED BY LOS ANGLE/ COUNTY AND STAYS OF SEWAG[DIBPOAAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOLD/k SEWER s
SIO NATURE BACKFILL■[PLIC TAHKf ❑
bF F[R MITTiI EP,P17(S) LI Cw FOOLJ
VAIJDATIO JACK R. ALLEN
8UP [SING MECHANICAL ENGINEER
` CK. M.O. CASH
LACO 7 6 4 5,;S' DIN 1 .3 1 0 A 5.QO- $