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HomeMy Public PortalAbout9303 BLACKLEY ST_Sewer__ CIEBOe111_57 APPLICATION FOR PERWIT k COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL' DEPARTMENT OF COUNTY ENGINEER' - BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMME, County En weer ADDRESS CASSAT! D GRIFFIN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST "LvS LEGAL DESCRIPTION LOT NO Ap OWNER 1 BLOCK TRACT// f7/ MAIL ADDRESS ��// d NO OF BLDGS © 1 SIZE OF LOT !\ NOW ON LOT CITY TEL NO _ USE OF I BUILDINGS DISTRICT NO GROUP /I MAP CONTRACTOR f77 / �� �K I oplyy ADDRESS /��� CONNECTION DATA CITY TEL 0 T ��� STATION "�' DEPTH REGISTRATION NO COU TATETY MANHOLE REFERENCE 'U PeFR LOWER NO DESCRIPTIO WORK FEE OUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 50 SEPTIC TANK SEEPAGE PIT OR TYPE OF ION LENGTH FROM Y PITS AND/OR DRAINFIELD @ $3 00 CURB P L M L TO P L OCZ OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 HOUSE SEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO S ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL - CHARGES TT OWNERS PERMIT S 1 [000a CONNECTION CHARGE FEE AUTHORIZATION- TOTAL FEE y J CJ REIMBURSEMENT FEE 1 HAVE AT THIS-DATE A-CONTRACT WITH THE-HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE 1NSP CTOR SSIGNATURE TO THE PUBLIC SEWER _ _ _ _ d _ SIGNED THIS `-DAY OF - 19 NEW HOUSE SEWER O �� OWNER _OR' - _ —7. n_ _ - - -- - - CONNECT ADDITIONAL- •- - --^ - '" ' OWNERS AGBUILDING OR WORK ADDRESS - - - -- - - - SEPTIC TANK,SEEP,PIT(S) -- -- -- - AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION `s + _ 2 ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑-DRYWELL F-1 - - -•> WITH ALL COUNTY ORDINANCES-AND STATE LAWS REGULATING PLUMBING AND SEWERS ALTER REPAIR,SEWER OR 1 HEREBY CERTIFY THAT-I AM PROPERLY REGISTERED AND/OR- SEWAGE DISPOSAL SYSTEM CE LINSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER _ DESCRIBED RESIDENTIAL PROPERTY- BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PIT(S) [ICESSPOOLS IJ OF PERMITTEE OF - - - VALIDATION ROBERT A WOOD _ - _-- y - CK__ m_0 CASR SUPERVISING MECHANICAL ENGINEER LAC4 3- 0 5AUG 28 10 A 4-.50 1, 7BAe42D APPLICATION FOR PERMIT cEeoe 11-s� COUNTY OF LOS ANGELES + � ,. SEWEF�-SEVVAGE_DISPOSAL:.^, DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ��® ►���� s '�!. JOHN A LAMBIE, County En eer ADDRESS 7 _ - CASSAIT D. GRIFFIN, Supt of Buildmg LOCALITYmmm NEAREST 'e.4 Tas F R PPLIC O FILL IN ceoss ST //�C FP �5/ r - ; LEGAL - ' DESCRIPTION LOT 0 OWNER A eAl ���E� �m'4t'V�� I - MAIL BLOCK TRACT /L ADDRESS ���� �� + ~~i� SIZE OF LOT NOWNO OON LOTS CITY /�►✓�� " EL NO oP��� USE OF BUILDINGS DISTRICT NO GROUP I MAP CONTRACTOR BK PG ADDRESS I?gO3 4. BZ.4<e1_j6V S7 - CONNECTION DATA CITY jFMpA_ TEL NO �p�—T,0G STATION DEPTH STATE TY MANHOLE REFERENCE UPPER REGISTRATION NO H COUN LOWER NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 50 SEPTIC TANK SEEPAGE PIT OR TYPE F CONNECTION LENG FROM ITS AND/OR DRAINFIELD @ $3 00 Y CURB P L M L,4 0 P L OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $200 HOUSE SEWER CONNECTING TO C NO PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO OB NO CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO p '4' ' A ABANDOy HOUSE SEiIFGA9&DISPOSAL SYSTEM @ $1 00 ^ STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL - CHARG OWNERS PERMIT $ 1 `,00 CONNECTION CHARGE FEE RIZ AUTHOATION 'TOTAL FEE .7 !� REIMBURSEMENT FEE 1 HAVE-AT-THIS DATE A CONTRACT WITH-THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19 NEW HOUSE SEWER OWNER OR - - - - -- CONNECT ADDITIONAL - --- - - - -- - OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP, PIT(S) - -- - - - - - ADDRESS - -' - AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO_COMPLY CESSPOOL❑ DRYWELL❑ - -WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS ALTER REPAIR SEWER OR 1 HEREBY CERTIFY-THAT 1 AM PROPERLY-REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM - - - - - - LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIACLLJP eJJeJJPERT�YY �+ BACKFILL SEPTIC TANKS El SIGNATURE r /�'�""" Cyd' SEEP PIT(S) ❑CESSPOOLS OF PERMITTEF- ®r - v VALIDATIOI,Ty�+1 ROBERT A WOOD CK a o i/ cpsx SUPERVISING MECHANICAL ENGINEER - - LACO3 8 5 0t 1 -10 A _ .Q 0 "�