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Home My Public Portal About9330 BLACKLEY ST_Sewer__ 0-63 76A842D APPLICATION FOR PERMIT/ 6A842 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, County Engineer ADDRESS CC WILLIAM A JENSEN Sup t of Building LOCA LTV NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ` q.Z ADDRESS NO OF BLDGS SIZE OF LOT 4J NOW ON�LOT CITY S TEL NO SE OF BUILDINGS �C DISTRICT NO GROUP MAP PROCESSED]- U Y `-/ BK PG CONTRACTOR �7 ADDRESS �tim� Z(J ��✓// CONNECTION DATA CITY EL NO STATION` DEPTH 1H STATE MANHOLE REFERENCE UPPER REGISTRATION NO LJ COUNTY `� -_ LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER 55 00 PC NO d SEPTIC TANK SEEPAGE PIT OR CO IMP N JOB NO O PITS AND/OR DRAINFIELD $1000 V HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM $300 T' CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAI ex eASEMCNT RECO130 STR NO DATE `O WORK TO HOUSE SEWER $3 00 0 y OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE @ $500 � 93- R ANDON HOUSE HWY OR ST WIDENING h SEWER OR �M @ E3 00Z _ STATE ENCROACHMENT _ PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMs s 00 CHARGES CONNECTIO HARGE FEE AUTHORIZATION I TOTAL FEE 9 / I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMRSEMENT FEE HAVE TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEW DATE INSPECTOR S SIGNATURE SIGNED THIS rDA Y OF 19 OWNER OR .� NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANKSEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAT NFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL [:1 I 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 aF INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DES BED RES• TIA ROPERTY ABANDON HOUSE SEWER SIGNATUREOF PERMITTEE - .� BACKFILL SEPTIC TANKS ❑ Y iSEEP PIT(S) ❑ CESSPOOLS ❑ (d ALIDATION ROBERT A wooer SUPERVISING MECHANICAL ENGINEER CK M O CASH 8 9 9 7 ZL r,:Xf ? 9 1 0 D rz.O 0 TEMPLE CITY 6A642 D 0_82 7APPLICATION FOR PERMIT 8A842 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, County Engmeer ADDRESS WILLIAM A JENSEN, Sup't of Buildmg LOCALITY Teml)le City T FOR APPLICANT TO FILL IN CROSS NEARES5T Enc inita LEGAL DESCRIPTION LOT NO OWNER Bi 11 Burge L MAIL BLOCK if TRACT / �" ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT 1 CITY TEL NO USE OF BUILDINGS Res• ` DISTRICT NO GROUP MAP� /P� PR/O/C/E�SSSSSEE}D BY r <�/ l ICONTRACTORSquareB K Deal Sewer Service �,..�� 0 J ADDRESS2933 jula son Rd. CONNECTION DATA CITYEl te TEL NO 020 STATION DEPTH f�f� (y.-�I STATE COUNTY MANHOLE REFERENCE UPPER (.,VV O IJ REGISTRATION NO 1nLOWER NO DESCRIPTION OF WORK FEE TYPE OFC ONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L MIL TO P L d PUBLIC SEWER @ 35 00 P C NO O SEPTIC TANK SEEPAGE PIT OR JOB NO PITS AND/OR DRAINFIELD @ 51000 CO IMP NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ 53 00 CONNECT ADDITIONAL BLDG OR 00 AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE fu WORK TO HOUSE SEWER @ $300 d OVERFLOW SEEPAGE PIT DRAINFIELD N EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 Z ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT S 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE REIMBURSEMENT FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER .D OWNERS AGENT CONNECT ADDITIONAL I ��}_ ��,.r-� �• ��j� BUILDING OR WORK ADDRESS // E Y •j/ SEPTIC TANK SEEP PIT(S) C I HEREBY ACKNOWLEDGE THAT 1 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 El El I 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 NO INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL OP TY ABANDON HOUSE SEWER SIGNATURE C`�l�/�� BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ AL r,c-..,,., IDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER M 0 CASH E808 ,°-63 A 6442 D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE SPOSAL 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 GRD55 5T LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO OF SLOGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS �a BK PG CONTRACTOR f O ADDRESS CONNECTION DATA STATION DEPTH CITY TEL NO STATE MANHOLE REFERENCE UPPER REGISTRATION NO COUNTY LOWER NO CESCRIPTI N OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L a PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR PC NO O CO IMP NO .108 NO PITS AND/OR DRAINFIELD @ 51000 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO w PRIVATE DISPOSAL SYSTEM @ $3 00 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAI 7 [ASEM6NT RECORD INSTR NO DATE V` WORK TO HOUSE SEWER @ $300 }V• OVERFLOW SEEPAGE PITO RAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE @ 55 00 a ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N SEWER QR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERV I PERMIT $ 21 Oo CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE t (JC,J I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 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 WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING 1 PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL I HEREBY CERTIFY THAT I A PROP ' LY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY L AN S COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM AL OWNER.-OF INTEND TO DISCONNECT PLUG AND RESIDE IN TH ES RIBED RES I OPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATIO ROBERT A WOOD CK M O SUPERVISING MECHANICAL ENGINEER CASH Leo 5 1 0 2 G OCT 21 1 0 D 5.00-