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Home My Public Portal About9435 BLACKLEY ST_Sewer__ 76A64 10_e2 APPLICATION_-F,=OR-PERM T 78A842D � -- COUNTY OF LOS ANGELES SEWER-SEW E POSAL DEP RTMENT OF COUNTY ENGINEER B ILDING AND SAFETY DIVISION BUILDING OHN A LAMBIE County Engineer ADDRESS v W AM A JENSEN, Sup't of Building LOCALITY NEAREST F APPLICANT TO FILL CRo55 er LEGAL DESCRIPTION OT NO '1 OWNER MAIL BLOCK TRACT ADDRESS NO OF BLDGS �f O SIZE OF LOT NOW ON LOT CITY TEL NO i( USE OF BUILDINGS DISTRICT NO GROUP MAP PROCES ED BY Ar BK PG f CONTRACTOR [ADESS CONNECTION DATEL NO STATION Ll �k —� O DEPTH t T TE MANHOLE REFERENCE UPPER REGISTRATION NO ❑ COUNTY NO GESCRIPTION Or WORK FEE TYPE OF CONNECTION LENZ.7H FROM d HOUSE SEWER CONNECTING TO Y CURB P L M L O P L O PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR PC NO V PITS AND/OR DRAINFIELD $10 00 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM $3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WIVEY EASEMENT RECORD INSTR NO DATE W WORK TO HOUSE SEWER @ S300 91 OVERFLOW SEEPAGE PIT DRAINFIELD Z EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 d/� HWY OR ST WIDENING ALTER N HOUSE SEWER OIY - SYSTEM @ 53 00 STATE ENCROACHMENT PERMIT N INDU 9 J E P RO 'Cr CHARGES OWNER'S PERMIT t 2 Oo AUTHORIZATION TOTAL FEE 0o- CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREI NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNE ABOVE D�RI D E%IS NG DW ELLI G TO THE PUBLICAPPROVALS DATE INSPECTOR S SIGNATURE SIGNED THISDAY ,1 OWNER OR NEW HOUSE SEWER OWNERS AGENT 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 WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER cRIMXTR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF B iX_DlSP0eA L+SY.BifiM CALIFORNIA OR THAT/I AM TH LEGAL OWNER O AND INTEND TO DISCONNECT PLUG AND Y RESIDE IN THE AB DESC ED E IDEN�I ROPERTY ABANDON HOUSE SEWER SIGNATURE G BACKFILL SEPTIC TANKS ❑ OF PERMITTEE 7 SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER CE808 042113 62 78A642b APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWA E D/j§POSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING y JOHN A LAMBIE County Engmeer ADDRESS WILLIAM A JENSEN, Sup t of Burldmg LOCALITY NEAREST FOR APPLICANT O FILL IN CROSS ST LEG DESCRI ON LOT NO MAIL BLOCK TRACT ��j/,. �,.� _ f ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP BK MAP PG PROCE ED BY BUILDINGS ogCONTRACTOR ADDRESS /{..�� CONNECTION DATA C Y -/ [� EL STATICNL IZ_, Ir DEPTH 43 TATE MANHOL`E7REFERENCE) UPPER REGISTRATION NO (✓ / El COUNTY / a. ' NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION NG7H FROM a HOUSE SEWER CONNECTING TO Y CURB P L L TO P L O PUBLIC SEWER $5 00 SEPTIC TANK SEEPAGE PIT OR J C NO V P175 AND/OR DRAINFIELD @ $10 00 CO IMP NO OB NO '7ce HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM $300 f1(—� CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIY[R EASEMENT RECORD INST DATE Y WORK TO HOUSE SEWER @ $300 L44YYJJ a OVERFLOW SEEPAGE PIT DRAINFIELD h EXTN CESSPOOL DRYWELL MANHOLE @ $500 yJ'rZ ALTER REPAIR OR AB NOON HOUSE HWY OR ST WIDENING i R OR P �Y EM @ $300 STATE ENCROACHM T PERMIT NO INDU RIAL ../ WASTbf APPROVA OWNER'S PERMIT ES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE 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 LANSTATE S AGENT CONNECT ADDITIONAL BUILDING OR WORK S SEPTIC TANK SEEP PIT(S) EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALL COUNTYORDINANCES AND STATE LAWS REGULATINGING AND SEWERS CESSPOOL ❑ DRYWELL ❑REBY CERTIFY THA I AM PROPERLY REGISTERED AND�OR ALTER REPAIR SEWEROR ED AS REQUIRED Y LOS ANGLES COUNTY ArjD STATE OF SEWAGE DISPOSAL SYSTEMRNIA OR THAT THE EGAL OWNER OF INTEND TO DISCONNECT PLUG AND IN THE ABO DESCRI tJ NTI P RTY ABANDON HOUSE SEWER URE �' / BACKFILL SEPTIC TANKSERMITTEE �+�'' SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATIODT- " ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O AS Li `o 7 G 3 2 2 6 1 1 D 2 5.0 0-