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Home My Public Portal About9537 BLACKLEY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL `1 ,DIVIS3.ON OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES / WILLIAM J. FOX, COUNTY ENGINEER BUILDINGADDRESS G.�zz LOCALITY /TO \\ FOR APPLICANT FILL IN - BUILDING NEAREST ADDRESS CROSSST. LOCAL DISTRIC�. kk SERIAL NO. PERMIT NO. c NEAREST n r ti �`'iF -7 S CROSS ST. — / RECEIV D�y) Ready for Inspection DAT§,ISSSS'UED OWNERMAIL �� ADDRESS �� USE ZONE' OCCUPANCY CITY TEL.NO. (a' a -'l � � I I � PG 9 CONTRACTOR -7e ADDRESS JOB J3+� .NO. B;QY TEL.NO. 'y? TRUNK PERMIT NO. STA E REGISTRATION N . �/ COU 4 ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO.2E(�/7.,3iS ®��•�� STATE ENCROACHMENT PERMIT NO. BLOCK TRACT -/®J.S®®®✓ �9 �lGfn VDUSTRIAL ASYE APPROVAL SIZE OF LOT a NOW ON LOTS CHARGE USE OF BUILDINGS CONNECTION CHARGE FE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE J BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR / E EPTIO RECORDED WORK TO HOUSE SEWER 1.00 G ALTER OR REPAIR EXISTING NO I D TE (BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/ORDRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE �.. UPPER OWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT ; I Y. CURB P.L. M.L.TO P.L. -- AUTHORIZATION I TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SSF�VER SIGNED THIS_..'... AT (/lF NEW HOUSE SEWER CONNECT ADDITIONAL / y \ OWNER OR �O9„ /fJ�"� gUILDING ORWORK OWNERS AGENT: .. - - _.. ..Y - l SEPTIC TANK,SEEP.PIT(S) ADDRESS..............._...... _...... ....._.._......_.._.._.....----••----.._.._........ AND/OR DRAINFIELD I HEREBY ACKNOWLEDG THAT I HAVE READ.THIS APPLI- CESSPOOL DRYWELL `CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND -AND/OR LICENSED A GUIRED BY LOS ANGELES COUNTY AND STATE OF CAL ORN OR THAT I AM THE LEGAL OWN- ABANDON HOUSE.SEWER ER OF THE ABOVE SCR BED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS � SEEP.PIT(S)� CESSPOOLS[] SI NARMIT E �,/J� � I _ OF PERMIT E-.. .. ..-_ C!/� ✓.-A!_ /' ,r.Ara9,A cra f3. rl 76A 420-CE806 - 10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER 1 BUILDING AND SAFETY DIVISION 7F-7'1 OPROCESSED FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. OWNER MAIL /n 1BLOCK TRACT ADDRESSNO. OF BLDGS.SIZE OF LOT NOW ON LOT CITY .�J7j/� TEL. NO. USE OF DISTR CTNO. GROUPJ MAP BUILDINGS PGCONTRACTOR ADDRESS ' --^l L i.� CONNECTION DATA ^7 _ I- T ION DEPTH CITY TEL. STATE / - J6, LIC y I LICENSE NO:; CLASS � MANHOLE REFERENCE LOWER NO. DESCRIPTION OF WORK FEE T E OF C NE I LENGTH FR M 30 HOUSE SEWER CONNECTING TO Y. U P. M.L.TOP. . PUBLIC SEWER @ $7.00 n SEPTIC TANK.SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO. IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ S3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVEREASEMENT RECORD. INSTR.NO. DATE u WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD O EXTN..CESSPOOL,DRYWELL. @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING ~ SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT W PERMIT NO. n. MANHOLE $7.00 INDUSTRIAL h WASTE APPROVAL CHARGES OWNERS PERMIT s AUTHORIZATION TOTAL FEE L� OLD CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING El AND SEWERS. CESSPOOL [IDRYWELL IHEREBY CERTIFY THA i AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR LICENSED AS REQUIRED O ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT M H LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A S BED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKI/ILk SEPTIC TANKS ❑ OF PERMITTEE SEEP/PIT(S) CESSPOOLS ❑ VALIDAT O CK. M.O. CASH , x' 958-' sem 8i1 30.00N eti 7 96 76A 642b -CES08 -10-71 APPLICATION FOR PERMI • COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL ,,DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING WA ADDRESS /tel LOCALITY -�\ NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL /7 DESCRIPTION LOT NO. OWNE b{. 'Q/ AIL BLOCK TRACT /�l�/`� _✓ ADDRESS SIZE OF LOT ` NOW OON LOTS CITY , TEL. NO., USE OF �e BUILDINGS L✓w 12 DISTRICT NO. GROU$ MAP PROCESSED BY BB�K' PS ,/7 CONTRACTOR ADDRESS } CONNECTION ATA V if CITY TEL. NO. (� ON DEPTH L CENSE NO; GLASS��TATE Ic MANHOLE REFERENCE LOWER NO. 1 DESCRIPTIO OF WORK FEE TY OF CO ECTI LENGTH FROM �� HOUSE SEWER CONNECTING TO Y. R P M.L.TO P.L. PUBLIC SEWER @ $7.00 0 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD � $10.00 CO.IMP. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. a PRIVATE DISPOSAL SYSTEM @ 83.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER -EASEMENT RECORD. INSTR.NO. OATE V WORK TO HOUSE SEWER @ S3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL. @ S5.00 ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING O 0 SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT W MANHOLE $7.00 PERMIT NO. a- INDUSTRIAL H WASTE APPROVAL z OWNERS PERMIT s 3 00 CONNECTION CHARGE FEE CHARGES AUTHORIZATION1 TOTAL FEE IHAVE 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 INSP OR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGEf,T CONNECT ADDITIONAL ADDRES / BUILDING OR WORK SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLE GE T I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOV IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ElDRYWELL E3 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT T LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB E IBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ElOF PERMITTEE SEEP.PIT S) C] SPOOLS VALIDATION CK. M.O. CASH ,I[ L,,U,U 7 5,1 - SE) 8 1 0 D 10,00f,4