HomeMy Public PortalAbout9457 BLACKLEY ST_Sewer__ 1
7
5&E"B 311155 APPLICATION FOR PERMIT
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS -7
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR AP LICANT TFI L / CROSS sT
LEGAL W, &I A OWNER
DESCRIPTION LOT NO
MAIL
BLOCK TRACTADDRESS
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO _ GROUP MAP
BK PG
CONTRACT0 �1/f. , 6;�
/
ADDRESS CONNECTION DATA
��� ��! STATION ���
Y � O EPTH ,
CITTEL N
MANHOLE REFER PPE
El STAAE
REGISTRATION NO G '2_ �� '� �❑ COUNTY
No DESCRIPTION OF WORK FEE TH FRS
tA
HOUSE SEWER CONNECTING TO L_�7 Y TYPE OF CURgECTIONP L TOP LO
PUBLIC SEWER @ $3 50 5 v
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00 cc Z7
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO� '-' JOB NO
EXTN CESSPOOL,DRYWELL,MANHOLE Q $2 00
HOUSE SEER
PRIVATE DISPOSAL SYSTEMG TO Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO/0,1Z/0�
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PEST $ '11 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE Q
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPI CTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER _
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER ORBUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS 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
SEEP PIT(S) ❑ CESSPO [I
2,g
PERMITTE r ���
ommuMam igL — -.-"
JOHN A LAMBIE'YCOUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLEIG INSPECTOR
/CK J Id 0 CASH _
LAS 5 5 3 FB 2 6 ` 4 4.50 '�
APPLICATION FOR PERMIT
7SA642D
B @ E 889 11 88.
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
D'gpoitment of County Engineer
County of Los Angeles BUILDING
� j
JOHN A LAMBIE COUNTY ENGINEER ADD
RESS
€/
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR , cSS R. sTLEGAL
DESCRIPTION t LOT NO OWNERS.
MAIL
BLOCK TRACT ti �. ADDRESS
NO OF BLDGS f CITY TEL NO
SIZE OF LOT NOW ON LOT ,
USE OF
BUILDINGS DISTRICT NO I GROUP I K MAP
BK PG
CONTRACTOR
ADDRESS1CONNECTION DATA
�� STATION � TH
CITY TEL NO PPER
MANHOLE REFERENCE
C3STATE
REGISTRATION NO (i� _ f�'� Q❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM i
PUBLIC SEWER @ $3 50 Y CURB P L M L TO P L
SEPTIC TANK,SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN ,CESSPOOL DRYWELL,MANHOLE @ $2 00 JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO Q(
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL ,
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
n CHARGES
CONNECTION CHARGE FEE
OWNER'SPERMIT
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
EP PIT(S) ❑ CES OLS❑
.d �
OF PERMITTEE
JOHN A LAMBIE. COUNTY ENGINEER _VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK d 0 CASH
05537L, FEB 26 5 25.00