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Home My Public Portal About9545 BLACKLEY ST_Sewer__ 1D.B2 76Aa42D APPLICATION FOR PERMIT 76A E4 - - " COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY,DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDREss WILLIAM A. JENSEN. Supin Supt of Building e'- fj�O r LOCALITY (•.. NEAREST FOR-APPLICANT TO FILL IN CROSS ST E LGAL (� DESCRIPTION LOT NO L�M f.a OWNER ✓� rt /^+' BLOCK TRACT �j C �/ �p� ADDRESS 76940 �•. CJ NO OF SLOGS SIZE OF LOT NOW ON LOT CITY /, f TEL NO USE OF BUILDINGS DISTRICT NO I GROUP MAP PROCESSED BY PG CONTRACTO.5 49V A ILL•= — 2 ADDRESS �- .�I! - CONNECTION DA A CITY F TEL NO /t(/ STATION D H TE MANHOLE REFERENCE UPPER REGISTRATION NO �7 COUNTY LOWER ,NO DESCRIPTION OF WORK FEE TYPE F zbNNECTIOIq LENGTH FROM as HOUSE SEWER CONNECTING TO Y PL qpL TOP L O PUBLIC SEWER @ ss 00P NO U SEPTIC TANK,SEEPAGE PIT OR CO IMP N JO NO PITS AND/OR DRAINFIELD @ 810 00 ce HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 - Q CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEI ENT RECORD INSTR NO DATE W WORK TO HOUSE SEWER @ 5300 C. OVERFLOW SEEPAGE PIT,DRAINFIELD N EXTN CESSPOOL,DRYWELL,MANHOLE @ SS 00 Z ALTER,REPAIR OR ABANDON HOUSE HWY ORST ENING SEWER OR DISPOSAL SYSTEM f3 00 STATE ENCROACH ME PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL-FEE CONNECTION CHARGE FEE 1HAVE 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 SANA SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR ND�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 ❑ DRYWELL ❑ IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR - LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND TATE OF SEWAGE DISPOSAL SYSTEM ,CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND NTEND TO DISCONNECT PLUG AND - RESIDE IN, THE ABOVE"DES RIBED RESIDENTIAL PRO RTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF-PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD cK M o CASH SUPERVISING MECHANICAL ENGINEER � 2 9 8 1 NOV 2 9 1 0 D 5.0 0- ,0.82 76A642D APPLICATION FOR PERMIT 78A84 - COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY,DIVISION BUILDING �— . r,`� e JOHN A. LAMBIE, County Engineer -ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL I CROSS ST LEGAL DESCRIPTION LOT NO �44C/ OWNER BLOCK TRACT L �J �1� ^ ADDRESS 7�� . (� f NO OF BLDGS. SIZE OF LOT NOW ON LOT CITY A TEL -NO. USE OF DISTRICT NO. GROUP ��Cj{/�M%AP PROCESSED BY [BUILDINGS '/I/1 J �J�J y/1' /� PG CONT RA CT O5j Sy�L/�[�4Y � �i�1� �� S��J y, r`r 10 Y _ ADDRESS �-� �•. f! - l f CONNECTION DA A CITY � � I'#- TEL NO ay z, /�e STATION D H `�`� ATE MANHOLE REFERENCE UPPER REGISTRATION NO - ,� key%- / ❑ COUNTY I LOWER NO. DESCRIPTION OF WORK FEE TYPE F NNECTIO LENGTH FROM HOUSE SEWER CONNECTING TO Y. �. P L •L.TO P.L. O PUBLIC SEWER @ $5 00 P NO V SEPTIC TANK,SEEPAGE PIT OR CO IMP.N JO NO PITS AND/OR DRAINFIELD $IO 00 Ix HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL BLDG OR dAFFIDAVIT WMVEN EASEMENT EC RORD. INSTR.NO. DATE W WORK TO HOUSE SEWER @ $300 G a OVERFLOW SEEPAGE PIT,DRAINFIELD H EXTN,CESSFOOL,DRYWELL,MANHOLE @ $5.00 Z ALTER,REPAIR OR ABANDON HOUSE HWY OR ST ENING SEWER OR DISPOSAL SYSTEM @ $300 STATE ENC ROACHME PERMIT NO INDUSTRIAL WASTE APPROVAL - OWNERS PERMIT $ 2 00 • 0 CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE GAO e* I HAVE AT THIS DATE A CONTRACT WITH THE HER NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNA URE ,SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK /, •� - /�,��+�« ADDRESS SEPTIC TANKSEEP,PITS) 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 ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND,GSTATE OF SEW AGE D ISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND NTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE-DES RIBED RESIDENTIAL PRO RTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PITIS1 ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD cK M o CASH JSUPERVISING MECHANICAL ENGINEER r o 2 9 8 1- NOV 2 9 1 0 0 5.0 0- cv