HomeMy Public PortalAbout6026 BURTON AVE_Sewer__ 76A 602DD APPLICATION FOR PERMIT 6 0
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COUNTY OF LOS ANGELES SEWER—SEWAGE DI POSAL U
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION Bw LDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
CANFLL IN REARESTR T ) CRosS ST777
L //�� (nj L C[� /1.� OWNER
MAIL`f ADORESS
i NO. OF BLDG..
SIZE OF LOT NOW ON LOT. / CITYNO`��
US OF / DISTRICT NO. Gq CLASS MPP PROCESSED BY
BUILDINGS /�� /A BK PS RO /
CONTRACTOR
ADDREs A /�Cl .- %Y.� CONNECTION DATA
DEPTH
STA IO ` MANHOLE REFERENCE v0 UPPER
CENSE NO, CLABS 0/1
NO. DESCRIPTION OF WORK FEE T PE OFC tSN£ TIN LENGTHFROM J
PUBLIC C SEWER CONNECTING TO ® ��� i / 'T Y �ia_ C q .L/ M.L.TO P.L. _
SEPTIC 'ANK.SEEPA
GE PIT OR L/ IJ P.C.NO.
PITS gND�Ofl DRAINFIELD � SIO.00
CO.IMP. NO, JOB NO.
HOUSE SEWER CONNECTING TO
TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE BS
SYSTEM
19
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WA.... IAIIUU.T RECORD.INSTR.NO. GATE O
WORK TO HOUSE SEWER f3.00 V
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.CESSPOOL.DRYWELL.MANHOLE@ 55.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING O
SEWER OR DISPOSAL SYSTEM "Go STATE ENCROACHMENT u
PERMIT NO. W
Q
INDUSTRIAL IAI
WASTE APPROVAL Z
CHARGE.
OWNERS PERMIT s _ o0
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TOCONNECT THE ABOVE DESCRIBE EXISTING DWELL G APPROVALS DATE INSPECTOR SIGNATURE
TO THE PUBLIC SEW
WE
SIGNED THIS DA OF 9
OWNER DR EW HOUSE SEW ER Z` _
OWNERS AGENT ONNECT ADDITIONAL V�
ADDRESS 4lipII BUILDING OR WORK 40
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TDRAINIIELDANK.BEER, IS)
AND/OR DRAINFIELD
AN
STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES
S AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ OflYW ELL ❑
LIKHEREBY CERTIFY THAT I AM PROP REGISTERED ANO/OR ALTER. REPAIR,SEWER OR
E NSED AS REQUIRE BY LOS ANGLE C NTY ANO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT AM THE LEGAL OF. A INTENp TO p15CONNECT PIVG AND
RESIDE IN. THE E OESCRIBEp REBI L P TY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF P EE ❑
SEEP,PIT($) ❑ CESSPOOLS
ALIDATION ASH JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
M.O. C
l & 5 2 9 4- 14AY 26 1 0 A 1 0.0 O'" a
2"°
76A6a2D APPLICATION FOR PERMIT
]6A � I
COUNTY OF LOS ANGELES _ SEWER-SEWAGE DISPOSAL IILI,1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A. LAMBIE, COUNTY ENGINEER Aoo HE55 f5 v`yPc
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
FOR XPPLIUANT TO FILL IN NBARE ST
(PRINT OR TYPE ONLY) CROSS ST.
LEGAL _
DEG
OF IPTION LOT NOi OWNER ,��� `•
/ 3 MAIL
BLOCK TRACT J L Q 7 ADDRESS
NO. OF BLOGS.
S12E OF LOT NOW ON LOT CITY TEL. N
USE OF
BUILDINGS DISTRICT NO. GRDUPCILA ES MAP
PG PROCESSED BY
_ BK _
CONTRACTOR v .•1. I
ADDRESS Jr� CONNECTION DATA �l
/ ION .--`'\ p EPTH r
CITY TEL. NO. �l V
STATES NO, LIC
LICENMANHOLE REFERENCE r UPPER I I Q v ('L
NO. DESCRIPTION WORK FEE CLgS TYPE OF CONNEC 10 V LENGTH OM
MOUSE SEWER CONNECTING TO Y. G 8�� �L. M.L.TO�L. ZQ
PURLICSEWER S5.00
SEPTIC MNK.SEEPAGE PIT OH ' P.C.NO.
PITS AND/OR OHAINFIEL. ® SIO,00 CO_IMP. NO. 'S JOB NO. /.
HOUSE SEWER C
O
NNEC
T
I
N
G
TO TRUNK PERMIT NO. ROAD PERMIT NO./
PRIVATE 015P OSAL SYSTEM @ 53.00 ✓ 7 d
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT •Iv ASEx[M� RECORD.INSTR.NO. GATE O
WOR N TO HOUSE SEWER 49 33.00 u
OVERFLOW SEEPAGE PIT.ORAINFIEL.
EXTN..CESSPOOL.ORYWEL_.MANHOLE Q 55.00 O
ALTER.REPAIR OR ABANDON HOUSE HWY, OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM ® $3.00 STATE ENCROACHMENT V
PERMIT NO, w
INDUSTRIAL d
N
WASTE APPROVAL
OWNERCHARGES
S PEAMTP
AUTHORIZATION TOTAL FLJ / 1 CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON EIMBURSEMENT FEE
TRACTOR TO CONNEC HE ABOVE DE5 TI G DW G
TO THE PUBLIC SE APPROVALS qDATEINSPECTOq'S SIGNATURESIGNED THIS DAYOWNEg
OWNERS
NECT ADDITIONAL
ADDRESS ! BUILDING OR WORK
SEPTIC TA NK.SEEP.PIT IS)
HEREBY ACKNOWLEDGE THAT 1 Hq VE READ TH 15 APPLICATION AN.
DRA1NFIELD
AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE5 AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS. CE55PO [3L
OL DRYWEL
HEREBY CERTIFY TH AM PROPER Y REGIS BRED ANO/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRE BY LOS gNGL C NTT AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA M TME LEGAL O O AND INTEND TO —DISCONNECT PLUG AND
RESIDE IN, THE A RIBED RESID PROPE TV. ABANDON HOUSE SEWER
SIGNATURE
OF PER E SEEP.FPITISILL EPO TIC TCESSPOOLS
cK.
VALIDATION JACK R. ALLEN
M.D. , CASH' SUPERVISING MECHANICAL ENGINEER
p 5 6 N
MAY 2 6 1 1 A 3 0.0 0-