HomeMy Public PortalAbout6138 BURTON AVE_Sewer__ CE80W D 10-63
76A64 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILMV
JOHN A. LAMBIE. County Engineer AD DRBe7
WILLIAM A. JENSEN, Supt of Building LOcsNEARFOR APPLICANT TO FML IN ROSLEGAL �J / �/DESCRIPTION LOT NO. SIJC�(! OWNE ®�^�MAIL '!BLOCK TRgCT �� ADDRy B�r
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT 1RI CITY Q TEL. NO. J
.L OF
BUILDINGS DISTRIC'fJ . GROUP MAP PpOCE3 E BY
CONTRACTOR
ADDRESS /t �"�/�`-C:NJL✓Je-��'G 3GyA• (�" J� CO CTION DATA
CITY L•y, C TEL. NO. Z�`J� /� STATION DEPTH
—
NTATE
STATE
REGISTRATIONO. Q STATE MANHOLE REFER NCE
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LE TH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. }
PV.LIC SEWER ® $4.00 d
NO
SEPTIC TANK.SEEPAGE PIT OR P C. , O
PITS ANO/OR GRAINFIELD ® 510.00 CO.IMP, NO. JOB NO. V
HOUSE SEWER CONNECTING TO T.VNK PERMIT NO, ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM ® 33.00 O
CONNE CT ADDITIONAL BLDG.OR qF;DAV" MV EEtM[NL E ORD R,NO. GATE F
WORKTO HOUSE SEWER ® 33.00
OVERFLOW SEEPAGE PIT,ORAINF IELD I t�(/JJ�
— W
EXTN..CESSPOOL.DRYWELL.MANHOLE 0 35.00 d
ALIEB�BWM-BR-A84NOON HOUSE �1c-� HAI ORS IDENING Z
SEWER SYSTEM ® 33.00 '� (/ STATE ENC ACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OVJNE WS PERMIT s z OD CHARGES
AUTHORIZATION I TOTAL FEE V.9 CONNECTION CHARGE FEE I
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE /
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC BE R. DATE I NSPECTOWS1410 NATURE
SIGNED THIS DAY OF75J194 k �.-
OWNER OR 13� NEW HOUSE SEWER
OWNERS AGEN�TI�J �J ��/��J' p I` CONNECT ADDITIONAL �r - •/
AOOflE55 %U-J �-16467A Ey'L ep BUILDING OR WORK {
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP.PIT(5) % I
AMC STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ANO/OR GRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ '�
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED By LOS ANGLES COUNTY AND STATE OF SEWAGE 015Pp.A�SYSTSM��
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECTr PLUG AND
RESIDE IN, THE ABOV SCRIBED RESIDENTIAL OPERTY, ABANDON XSV$E.EW ER 4
SIE
OF PERMITTSACKFILI SEPTIC TANKS [_JOF ERE ❑
SEEP,PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. ..0.
CASH
1 1 7 9Z AL10 1 0 A 5.00" Q
DEPASTB ENT OF COUNTY ENGIN= SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDINGtAND SAFETY PERMIT APPLICATION
COIINTV OF LOS "(3EI.F$ x 9
WILLIAM J. FOX, COUNTY,4NOINEEN I ADDREBu1L01SS0
FOR APPLICANT TO FIL N LOCALITY _
BUILDING NEAREST
ADDRESS V I CROSS ST.
LOCALITY 27 OR JI5//// DISTRICT NO. Ready for Inspection'. PERMIT NO.
CNEAREST —ROSS ST. �l�it�l'I-F9A�.t� b I � I 36 7(S kS
DATE
RECEIVED BY �' DATE ISSUED BY/1
OWNER .may/V/J)/)'C fn-(Q�
MAIL
ADDRESS /I ,A /1y USE ZONE OCCUPANCY ON
MGP_PG
CITY - TEL.rNOO.
CONTRACTOR [:alt/at nia Sewer G,...e}r„r}inn CC? CO.IMP.NO.
ADDRESS f3r7 Faleg•^mc Ave- JOB NO.�
CITY Mr,ntP6elIFEL.KO_ California TRUNK PERMIT NO. --------- -�
STATE
REGISTRATION NO. D c j C ROAD PERMIT NO. ---------------LEGAL1
DESCRIIPTION LOT NO. S /� / STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT �e/J INDUSTRIAL
SIZE OF LOTcD !! WASTE APPROVAL
.✓ X3i/b NOWONLOTS CHARGES
USE OF •�c
BUILDINGS CONNECTION CHARGE-FEE,
NO. DESCRIPTI N OF WORK FEE
HOUSE SEWER CONNECT] REIMBURSEMENT FEE /w
NG TO
PUBLIC SEWEq aS 3.50 �7 U RECEIPT NO. I ATE I8Y
NG
HOUSE SEWER CONNECTITO
_ PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL SLOG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE\ ISY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR �/ q
PITS AND/OR GRAINFIELD 2.00 STATION 4 7' 3U DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 133 D 14,MANHOLEREFERENCE
UPPfiI� LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ DD V� -CURB— P.L. M.L.TO P.L. �C
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THEA EJDERISED E%ISTINO APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWE -` 1SIGNED THIS_ AY OF_- ._IYl NEW HOUSE SEWER 7 lcQ .
OWNER on CONNECT ADDITIONAL V
OWNERS A(Fr6NT... �r� _ — BUILDING OR WORK
SEPTIC& A .ZL. - ff_ -t-7,7 - ----- AND/OR GRAINFIELD
ELD PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THI APPLI- CESSPOOL C] 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/GR LICENSED AS REOU RED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF C F NIA R NAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE AB SCflI ESIDENTIAL PROP TY. BACKFILL SEPTIC TANKS n 5 131
SIGNATURE SEEP.PIT(S) CESSPOOLS p_K./l /�
OF PERMITTE -.._..---�.--._...__ .__.. .--._.._.-- J v
T6A642D S&E 663 4/54