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Home My Public Portal About9431 BLACKLEY ST_Sewer__ ;S&E 6D APPLICATION I-I PERMIT1 ✓} 2D 12 54 DIVISION SION OF BUILDING AND SAF " SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING WM.J FOX, COUNTY ENGINEER ADDRESS ' CArSSATT D. GRIFFIN, SUP T OF BUILDING LOCALITY KOR SIA A FII1 N NEAREST EARE CROSS ST F7 r DESCRpIPTION LOT NO 1;.��, , /'✓�/��L. OWNER BLOCK TRACT V MAIL ADDRESS NO OF BLDGS /y SIZE OF LOT NOW ON LOT �..(/ CITY r TEL NO USE OF r BUILDINGS (� DISTRICT NO GROUP MAP PG CONTRACTOR r 15) BK �O ADDRES,�� , CONNECTION DATA CITY -� L NO :' STATION / 1-,9-3, /-J DEPTH STATE - 7 J MANHOLE REFERENCE REGISTRATION NO Y ❑ COUNTY �g / W LOWER TYPE OF CONNECTION LENGTH FROM `�n NO DESCRIPTION OF WORK FEE Y 00" fit. M L TO P L HOUSE SEWER CONNECTING TO � y PUBLIC SEWER ([� $ 3 50 � Al-�r /� HOUSE SEWER CONNECTING TO ' U�� (f)/v /; PRIVATE DISPOSAL SYSTEM 1 00 '0 CONNECT ADDITIONAL BLDG OR CO IMP NO J" NO 7 WORK TO HOUSE SEWER 1 00 AQW ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PEPMIT NO JC)0 DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT ! PND/OR DISPOSAL SYSTEM 1 00' PERMIT NO SEPTIC TANK SEEPAGE PIT OR i --PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL HASTE APPROVAL CESSPOOL- DRYWELL SPECIAL CONDITIONS ONLY 2 0/0� CHARGES rCONNECTION CHARGE FEE OWNERS PERMIT 0 coz AUTHORIZATION TOTAL FEE PEIMBURSEMENT FEE .2/1,'POP, I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSP CTOR S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER t SIGNED THIS -9 DAYOl1F / 19�I�' NEW HOUSE SEWER OWNER OR /A�� /,l�j J f CONNECT ADDITIONAL OWNERS AGENT // !LL-�UUUC CCCIIIaaa BUILDING OR WORK 9� � �a� ��u�sn�' SEPTIC TANK, SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ TH}S/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 HOUSESEW D I� CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCPIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ { � t'� SEEP PIT(S) [ICESSPOOLSq (A „L SIGNATURE Ad OF PERMiTTEEh4?_ . vzd_'-� j WILLIAM J. FOX, COUNTY ENGINEER VALIDATION BY JEO 6 6 1 7 U" AUG 15 3 5 2 1 1,8 �o 6 1 AUG 15 4 650 BY DEPUTY DEPUTY BY BY -® DEPUTY DEPUTY ce'r t ' ,0_82 76A642D APPLICATION FOR PERMIT 78A 84 COUNTY OF LOS ANGELES SEWER—S A(A 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 '�I F R P T CROss LEGAL �J DESCRIPTIO LOT O �i L�� OWNER x ♦ �� JJ MAIL BLOCK TRAC �/v/�� ADDRESS ' NO OF BLDGS I SIZE OF LOT NOW ON LOT CITY TEL N USE 0 BUILDINGS DISTRICT_NO GROUP MAP �PROCSED rK PG CONTRACTO ADDRESS CONNECTION DATA J CI Y TEL NO �® TION DEPTH _ 7S /) ATE CCIJ PER REGISTRATION NO e � UNTY MANHOLE REFERENCE NO DESCRIPTION F W RK FEE d TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO �`� Y CURB P L M L TO P L O PUBLIC SEWER @ $5 00 (f SEPTIC TANK SEEPAGE PIT OR P C NO CO IMP NO .108 NO PITS AND/OR DRAINFIELD @ $IO 00 p� HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N O PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR AT .Y_ WORK TO HOUSE SEWER @ $300 YYYYaJJJJ OVERFLOW SEEPAGE PIT DRAINFIELD N EXTN CESSPOOLDRYWELL MANHOLE @ $5 00 ^ Z ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING _J SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMEN 000\�� PERMIT NO IND RIAL S IALAL RG-ES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE QQ CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WI'yH THE HEREI NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT HE ABOVE DE I ED EXI NG DWELLI G z TO THE PUBLIC SE E APPROVALS DRAT 1 INSPECTOR S SIGNATURE SIGNED THIS Y OF 1 - .—I , OWNER OR NEW HOUSE SEWER ,` y„�t OWNERS AGENT CONNECT ADDITIONAL t' IT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) IH 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 PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY TH T I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRE BY LOS ANGLES COUNTY ND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF NO INTEND TO DISCONNECT PLUG AND RESIDE IN THE AB DESC ED ESIDENTI L OPERTY ABANDON HOUSE SEWER SIGNATURE BAKFILL SEANKS ❑ OF PERMITTEE SEECP PITPTIC T S) ❑ CESSPOOLS ❑ VALIDATIO%Ni-1 ROBERT A wooD l SUPERVISING MECHANICAL ENGINEER CK M O CASH Ltlyr7 0 _► ",a -M26 1 0 D 7.00- - ��