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Home My Public Portal About9113 BLACKLEY ST_Sewer__ i 11173 E6D 5& 83 it 6S APPLICATION 1FOR PERMIT 1 S 8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR PPLICANT TO FILL IN CROSS s - LEGAL OWNER DESCRIPTION 0 ef�ll _ Q MAIL BLOCK ACT i ✓ ✓ ADDRESS NO F BLDGS CITY TEL NO SIZE OF LOT NOW ON LOT USE OF BUILDINGS DISTRICT NO GROUP MAP 1 C BK PG (� CONTRACTOR CALIF.SEWER CONST. C ADDRESS 11317 COLEGROVE AVE. CONNECTION DATA CITY MONTEHELL'L NO PA 1-5048 STATION � t DEPTH 180757 A U. y .' TUTE) ❑ STATE MANHOLE REFERENCEZj _ UPPER REGISTRATION NO �/ ❑ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM PUBLIC SEWER @ $3 50 O d Y CURB P L M L TO P L SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD t@ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD P C NO EXTN CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $100 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $100 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $100 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 00 AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING S {t TO THE PUBLIC SEWER NEW HOUSE SEWER "'3 6 `N l SIGNED THISD Y OF I9 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT 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 SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY T AM PROP LY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REOUIR BY A GE COUNTY A D STATE OF ABANDON HOUSE SEWER CALIFORNIA OR TH I A E E A OWNER THE ABOVE DESCRIBED RESIDE IAL P Y BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PIT(S) ❑ CESSPOOLS OF PERMITTEE JOHN A LAMBIE COUNT G ER CALIDATION ROBERTA WOOD, CHIEF PLBG INSPECTOR II O CASH - �'n5 9 0 3 APR3 0 1 0 A 5.00 (.'%'[9'4 2 0,� f 8&E 6631183 APPLICATION FOR, PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of Lojj_Angeles BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRES ® CASSATT O GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLIC O IN CROSS sT a� LEGAL DESCRIPTION LOT NO OW M a BLOCK TRACT / IV NO OF BLDGS T 0 SIZE OF LOT N,0W ON LOT USE OF DI RIC' NO GROUP I MAP BUILDINGS BK PG CONTRACTOR ADD CONNECTION DATA yi STATION DEPTH TEL f •J ✓ MANHOLE REFERENCE ' _. ❑STATE REGISTRATION NO d ❑ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION ENGTH FROM �J PUBLIC SEWER @ $3 Y CURB P L M L TOP L SEPTIC TANK,SEEPAGE PIT OR , PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE PIT, DRAINFIELDP C NO EXTN ,CESSPOOL,DRYWELL MANHOLE Q $2 00 CO IMP NO An n JOB 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 ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 D REIMBURSEMENT FEE AUTHORIZATION -TOTAL FEE , I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, d NEW HOUSE SEWER SIGNED THIS DAY OF A 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS .. SEPTIC TANK SEEP, PIT(S) ADDRES AND/OR DRAINFIELD I HER Y ACKN LEDGE TAT-] HAVE READ T S APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND REE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE WS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN L PROPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑ OF PERMITTEE JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR CK N 0 CASH LAGo5 7 6 8L ;FR 27 1 0 A 5.00 ¢�! 7 DEPAWrMENT OF COUNTY ENGINEER_ SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS 9 I�L��r (vim FOR APPLICANT TO FILL IN LOCALITY T G BUILDING NEAREST ADDRESS �,� CR0888T p- Imo= � LOCALITY DISTRICT NO SERIAL NO PERMIT NO. NEAREST `� CROSS ST o n p Mrl9 RECEIVED BY Reedy for Inspection DATE ISSUED OWNER f Gu . C`�a 5�.4 �aa.�- Io n- C. c.� MAIL ADDRESS USE ZONE OCCUPANCY MAP BK PG CITY TEL NO /.:S,- I E�=S CONTRACTOR O• a) e .) CO.IMP NO ADDRESS 71_1 JOB NO CITY . TEL NO F �� _��r-g�, TRUNK PERMIT NO oo STATE REGISTRATION NO ♦ O BOt1'NTY ROAD PERMIT NO LEGAL STATE ENCROACHMENT j DESCRIPTION LOT NO PERMIT NO BLOCK TRACT DUST AL APPROVAL SIZE OF LOT NO OF SLOGS I NOW ON LOT CHARGES USE OF BUILDINGS - CONNECTION CHARGE FEE NO DESCRIPTION OF WORK FEE i REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 350 RECEIPT NOI DATE BY HOUSE SEWER CONNECTING TO v PRIVATE DISPOSAL SYSTEM 1 00 00 CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1 00 r ALTER OR REPAIR EXISTING �} N0 I DATE BY SEWER OR DISPOSAL SYSTEM 1 00 DISCONNECT AND ABANDON SEWER AHD/OR DISPOSAL SYSTEM 1 00 , CONNECTION DATA' SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 2 0 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 / MANHOLE REFERENCE UPPER LOWER TYPE'OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 Q0 Y CURB PL M L TO P L AUTHORIZATION TOTAL FEE b 1/ I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED / f HAVE TO CONNECT THE ABOVE DESCRIBED EXISTING - DAPPROVALS INSPECTOR/8-SIGNATURE DATE WELLING TO THE PUBLIC SEWER SIGNED THIS ___ ____ DAY OF. 19____ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT __ _ _ ___ ___ _ __ _ _ BUILDING OR WORK ADDRESS _ _ SEPTIC TANK,SEEP.PIT(S) / AND4GFl:INC*HWETx8 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL Ej DRYWELL E]CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ER-OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E] SIGNATURE n f SEEP PIT(S)� CESSPOOLS OF PERMITTEE_ _�.[.; Sf _ ____ , 76A642D 663 1/53