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Home My Public Portal About6022 BURTON AVE_Sewer__ D, T6A64zo APPLICATION FOR PERMIT enea COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDT JOHN A. LAMBIE. County Engineer ADDRESS �— A ,C/ - WILLIAM A. JENSEN. Supt of Building LOCALITY NEAREST ( / FOR APPLICANT TO FILL IN CRDR...S .T. EGPL DESCRIPTION LOT NO. � Q /�� OWNER (r } MAIL C BLOK TRACT �/ LY v ADDRESS NO, OF BLDG.. SIZE OF LOTJC �� NOW ON LOT CITY TEL. NO. U.E OF BUILDINGS DISTRICT NO. GROUP K MAP PROCESSED BY BPG CONTRACTOR ADDRESS CONNECTIO DATAY� CITY CxA I` TEL. NO.X- 7- 7 , STATION DEPTH / STPTE UPPER REGISTRATION NO. [I COUNTY RE ERENCE COUNTY / LOWER NO. DESCRIPTION OF WORK FEE TYPE 01 G& TION LEAGTH FROM HOUSE SEWER CONNECTING TO Y. C B P.L. ^L.TO P.L. PUBLIC SEWER @ 55.00P.0O 111`111 TANK,SEEPAGEPIT OR .NO. PITS ANO/ORORAINFIELD $10.00 CO.IMP. NO. /JOB NO. U HOUSE SEWS CONNECTING TO TRUNK PERMIT NO, ROAD PERMIT NO. p' PRIVATE DISPOSAL SYSTEM CA'S30p O CONN ECT A°DITIONAL BLDG.OR AFFIDAVIT MY I. RECORD. INSTR.NO, DATE 0 WORKTO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT,DRAINFIELD E%TN.,CESSPOOL,DRYWELL.MAN HO LE0 SS.00 A�R-ABANDON HOUSE .q HW Y.OR ST.WIDE tNG ' 5[OiReR DISPOSAL SYSTEM @ S3.00 3 STATE ENCROACHMENT L PERMIT NO. INDUSTRIAL WASTER ROVAL CHARGES OWNER'S PERMIT s 11 oo AUTHORIZATION I TOTAL FEE / CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'.SIGNATURE SIGNED THIS DAY OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,.EEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO pLCONNECT PLUG AND RESIDE IN, THE ABOVE ES IBED RESIDENTIw OPERTY. ABANOON HOUSE SEWER £ SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK M.o, CASH SUPERVISING MECHANICAL ENGINEER Ln-_*j 9 0 4 5 tG MAR 2 1 0 A 5.00- 76A642❑0-63 APPLICATION FOR PERMIT C E608 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER _ _ BUILDING AND SAFETY DIVISION JOHN A. E. County Engineer ADDvsss /// w'L•/L/A--�- WILLIAM A.. DENS]ENSEN. Supt QI Building LOCALITv NEAREST FOR APPLICANT TO FILL IN LRCS$ $T. LEGAL DESCRIPTION LOT NO. a/ L� /u S OWNER MAIL BLOCK TRACT �' (J� ADDRESS NO. OF eLOGS. SIZE OF LOT NOW ON LOT / CITY TEL. NO. USE OF BUILDING$ DISTRICT NO. GROUP MAP PROCESSED BY / :r BK 4FG CONTRgCTO /[— AODRE. CONNECTION DATA STATION ' DEPTH CITV J �•/TEL. NO. / 3Q /f UPPER RfGISTFATION NO. ZJ(/ STATE MANHOLE RE ERENCE "� ❑ COUNTY �� v LOWER NO. GESCRI PTION F WORK' F E TYPE OF COI3NEGf ON LENGTH FROM `�JY Y HOUSE SEW Eft CONNECTING TO /�� Y. CURB P.L. M.L.TO P.L. 'A2 C/ PV ELIC SEW ER @ 35.00 d SEPTIC TANK,SEEPAGE PIT OR �%O P.C.NO. O C O.IMP. NO. J08 N0. PITS AND/OR DRAINFIELD � $10.00 CJ HOUSE SEWER CONNECTING TO I TRUNK PERMIT NO, RDA.PERMIT NO. ar PFIVgTE DISPOSAL SYSTEM � $3.00 ^ CONNECT ADDITIONAL BLDG.OR AFFIDAVIT Mv[R •z[M[x RECORD-INSTR.NO. DA E VF WORK TO MOUSE SEW ER � $3.00 V OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CE5SPOOL,DRYWELL.MANHOLE@ $5.00 ' CIL ALTER, REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING E, SEWER OR DISPOSAL SYSTEM 1D $3.00 STATE ENCROACHMENT Z PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT $ 2 0d0 . CHARGES AUTHORIZATION TOTAL FEE /� CONNECTION CHARGE FEE '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING OWELLIN. APPROVALS / TO THE PUBLIC SEWER. DATE INSPEC R'S SIGNATURE SIGNED THIS DAY OF 19_ �U �� OWNER OR NEW HOUSE SEWER OW NERB AGENT CONNECT ADDITIONAL Y ADDRESS BUILDING OR WORK SEPTIC TARK.AI SEEP, PITIS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION COMPLY qN./OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND LAWS E COMPLY WITH ALL COUNTY ORDINq NCES qND STATE Lp WS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DkYW ELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.S EWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF 5EWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE A E DESCRIBED RESIOENTI L PROPERTY, ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP.PIT ISI ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD crc M.o. cases SUPERVISING MECHANICAL ENGINEER 09c 26 1 0 A 7.