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Home My Public Portal About9231 BLACKLEY ST_Sewer__ ,0.82 7GA642D APPLICATION FOR PERMIT 78A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, County Engineer ADDRESS WILLIAM A JENSEN Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS ST LEGAL i DESCRIPTION LOT NO 46 OWNER MAIL BLOCK // TRACT /�//- 'q� ADDRESS / (tea y� SIZE OF LOT 40 ��lpV / NOWOON LOTS CITY TEL NO USE OF DISTRICT NO I GROUP MAP PROCESSED BY BUILDINGS .�� BK CONTRACTO d./ O8 / 1O 7 ADDRESS G1 ._.J / CONNECTION DATA/ CITY TEL NO 4 STATION DEPTH ,/ STATE REGISTRATION NO ❑ CO NTY MANHOLE REFERENCE /, L �W/ OWER NO DESCRIPTION OF WORK FEE TYPE OF ION ICJ LJ LENGTH FRO 7� p CL HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L v 7 O PUBLIC SEWER @ 55 00 SEPTIC TANK SEEPAGE PIT OR PC NO V CO IMP NO JOB NO PITS AND/OR DRAINFIELD @ 31000 � Ix HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM @ S300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 _ a OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 p Z ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL �y CHARGES OWNERS PERMIT $ 21 00 AUTHORIZATION TOTAL FEE O CONNECTION CHARGE FEE ti REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DES CRI BAF EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS TE INSPECTOR 5 SIGNATURE SIGNED THIS DAY 19 OWNER OR NEW HOUSE SEWER OWNERS AG - CONNECT ADDITIONAL ) BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL 1:1DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE A5 VE D SCRIBED R DENTI L PROPE TY ABANDON HOUSE SEW ER SIGNATURE !/ / ❑ OF PERMITTE (/ / .� BACKFILL SEPTIC TANKS SEEP PITfS) ❑ CESSPOOL ALIDATION ROBERT A' WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH fl _956%-0 JUL 7 1 0 D 7.0 0- U T _ 1 78AE42D �' APPLICATION FOR PERMIT 8&ED688 iIVf ls� ISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County EngineerDINqy 7p COIIIIty Of LDS Angeles BUILDINADDRU'LESS SG �// JOHN A LAMBIE COUNTY ENGINEER P ® CASSATT O GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST R LEGAL /S DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT 1 D ADDRESS NO OF SIZE OF LOT f NOW ON LOTS CITY TEL NO 47 vv- USE OF V� DISTRICT NO GROUP MAP BUILDINGS CONTRACTOR L - 1 ®SK PFJ ADDRESS �j ,��J -(� I CONNECTION DATA CITY TEL NO .�� "IXATION DEPTH _ MA OLE REFERENCE - _ UPBW .. 1� (- ❑ S&E WER REGISTRATION NO ❑ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF NECTION LENGTH FRO Y CUTNL PL ML TOP PUBLIC SEWER @ $3 50 , SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD P NO EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO R D PERMIT NO CONNECT ADDITIONALd't= OR STATE ENCROACHMEN WORK TO HOUSE SEWER - @ $1 00 O PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPR L CHARGES CO CTION CHARGE FEE _ OWNER'S PERMIT S 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- HAVE APPROVALS DATE INSPECTOR SSIGNAT TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER ,� NEW HOUSE SEWER _ _ A SIGNED THIS�T DAY OF _ ]9 CONNECT ADDITIONAL /If /1 OWNER OR �O1_ 1,,. ��,�� BUILDING OR WORK - - '�Q f OWNERS AGENT _ T`T"� PP SEPTIC TANK,SEEP,PITS) io ADDRESS G "+ •� ZCv", ' 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 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 RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE ��,' j1� p�� SEEP PIT(S) C1 CESSPOOLS❑ OF PERMITTEE� JOHN A LAMBIE, COUNTY ENGINEER " VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR CK Id 0 CASH Lo 4 2 6 3 MAR 19 4 2.0 0