HomeMy Public PortalAbout6202 BURTON AVE_Sewer__ ;IEPARTDffiQT of couNTr ENGINEIIt SEWER—SEWAGE DISPOSAL ry
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ADDREBUILDING
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F
OR APPLICANT TO FILL IN, LOCALITY ^ /K 9X)+IiRX
�� )�, v3 _ y^�� NEAREST _'-
e., �"f �'A�).l..l/!/t/p/ 1 CROSS ST.
�• QDISTRICT NO. SERIAL NO. (PPERRMIT QNO.
/, Q� r AS
i fJ. I••�� �� Ready fpr Ineppetlon �i�ISSUUED
^ ^ USEZONE OCCUPANCY I •�MAP PG
ADDRESS /F�i–[/WLX (/�/\YJ'PA `� ' qq
CITY TEL.NO. ` l /l F
CONTRACTO081ifornia Sewer ConSt.CO. CO.IMP.NO. 441QS
ADDRESS 1317 Colegrove Ave. JOB.NO. -^-----
CITYMontebello TEL.IMNlon 1-5048 TRUNK PERMIT NO. -----
STATE
REGISTRATION NOL04445 Stc4OU NTY ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. \/ PERMIT NO. �'��
BLOCK TRACT V INDUSTRIAL
L
SIZE OF LOT " NOWASTE APPROVAL CHARGES
Xa 9SW ON LOTS
USE OF _72
BUILDING'S CON NECTION CHAftGE.FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOREIMBURSEMENT FEES '
PUBLIC SEWER G $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
Q CONNECT ADDITIONAL BLDG.OR EXCE ION RE`O RDED
WORT(TO HOUSE SEWER 1.00
Q ALTER OR REPAIR EXISTING NO'/I DATE I 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/OR DRAINFIELD 2.00 STATION 7'f' i DEPTH
CESSPOOL—DRYWELL
_ SPECIAL CONDITIONS ONLY 2.00 MANHOI F DEFERENCE
�r�Y /{e �tJPF LOWER
TYPE OF CONNECTION LENGTH FROM / O
OWNERS PERMIT s 1 00 .Y —CO� P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE �1, 5'1-)
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TOT E PUBLIC SEWER 11
SIGNED THIS. _ .. ...DAY OF......... _.......... ..............19..._..
NEW HOUSESEWER �6154-
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS . ..._......_........... .._.............._...... / . ......_
SEPTIC
ADDRESS.. .--y...V...�. /j /�ZL(1Z.Ld��fA AND/OR GRAINFIELD PIT(S)
.I HEREBY ACKNOWLEDGE THAT 1 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
AND/DR LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND
ANDISCONNECT ABANDON HOPLUS SAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El /
SIGNATURE �1 �//, �T Q�j/ SEEP.PIT(S)Q CESSPOOLS
OF PERMITTEEI,,,�,�...F_.. ..�...1_C,L� ............
....
..1-..-
i GA642D G63 1/53
''A862D APPLICATION FOR PERMIT
«BDB B.sa
COUNTY OF LOS ANGELES pO SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AOpgE55B 11
T
OHN A. LAMBIE, Count Ea ear
C SSATT D. GRIFFIN, Supt of Bnilding LOCALITY l7AI G/9 J�NEAREST
FOR APPLICANT TO FILL IN j !/
LEGAL OWNER �//fGK l� (?AZA r
DESCRIPTION LOT N0.
BLOCK TRACT MAIL�S^ (3,�_ ADD ESS �.� /-G�iYd T O t/¢^
N0.OF BLDGS.
SIZE OF LOT /1 O )(:I 0° NOW ON LOT CITYk A/G/,7. TEL. N0. I.
USE OF )
BUILDINGS VI-cd - DISTRICT NO.I GROUP I
BK PG �/J
MAP PRjj5111GGGESSED BY
CONTRACTOR
2
ADDRESS yT� �� -ro ✓ c- CONNECTION DATA '
CITYG Ar6/J, TEL.NO.._�1_ STATION7:4 O DEPTH /
u�
STATE MANHOLE REFERENCE
REGISTRATION NO. f LC �T B COUNTY 1,41 WER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM d /
PITS AND/OR GRAINFIELD
SEPTIC TANK.SEEPAGE IT OR @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.. CESSPOOL.ORYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK ERMIT N0. ROAD PE 0.
WORK TO HOUSE SEWER @51.00
' "" ""'" "'-I ABANDON HOUSE STATE ENCROACHMENT
5�.=:-�R-BSS=�ALSYSTEM @ $I.( PERMIT NO.
INDUSTRIAL
,. WASTE APPROVAL
CHARGES
OWNER'S PERMIT S 2 roo CONNECTION CHARGE FEE
AUTHORMATION I TOTAL FEE C�O REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING PROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS ��_-- AY OF f - 19 L�- NEW HOUSE SEWER
OWNER OReA CONNECT ADDITIONAL
OWNERSAGENT - BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL O
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWED OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND r�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTROP`RTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PITCIS) ❑ CESSPOOLS
OF PERM TIE,
®' VALIDATION ROBERT A. WOOD
C Y.0. CASH - SUPERVISING MECHANICAL ENGINEER
M5 5 8 6$ JAN 25 1 0 A 3.00 M