HomeMy Public PortalAbout6212 BURTON AVE_Sewer__ 9ABAEU
CAPPLICATION FOR PERMIT
eeos ese COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
RESS
CASSAITAD LARIMBI,rCSup
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of LOCALITY
NEAREST
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FOR APPLICANT TO FHIN CRO85 s .
LEGAL r
DESCRIPTION LOT NO OWNER
BLOCK TRACT i�t `51 MAIL
ADDRESS
NO.OF BLDGS. J
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP BK PG MAP PROCESSED BY
CONTRACTOR
''A/ T I
�/jTi ✓`✓ 12-
ADDRESS
")ADDRESS "yj CONNECTION DATA
CITY TELL�NO.�t b_f S STATION DEPTH
REGIST ION N0. �� / COUNTY MANHOLE REFEREN UPPER
f LOWER
NO. DESCRIPTION OF WOR FEEHOU �S
PUBLISEWER
WR
E EECONNECTING TO @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EKTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER.REPRfRBR-ABAJiDON HOUSE / �. STATE ENCROACHMENT
SEW ERO M @ $1.00 ! PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S Z OD CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE O REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING A PROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP. PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,R&SA}R-SEWER BA
PLUMBING AND SEWERS. Ii z���0
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA P RTY. W✓ BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE
®f VALIDATION ROBERT A. WOOD
CK. Y.o. GSH SUPERVISING MECHANICAL ENGINEER
1(062725 FEB 101 0 A 4.00
Parcel Map 501
DEBOB 3 B APPLICATION FOR PERMIT
]5AG42D
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER IIIIIIII
BUILDING AND SAFETY DIVISION 7ADDRE
/� nAve.
JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING
San rabriplFOR APPLICANT TO FILL IN, ongden
"G"` 2 in McCallum
DESLE PT ON LOT NO.BLOCK TRACT 31 ',� _C ?� 212 N Burt-on Ave*
p� `' s I NO. OF BLDG9`A_ 'd ab 161
SIZE OF LOT 0 .\ LI NOW ON LOT CITY TEL. NO.
U5E OF
BUILDINGS DISTRICT NO. GROUP MAP PR CESSED BY
BK PG
CONTRACTOR.�NGquaxe Deal_Sewe ervice '1 [ /I tt�•��`.ci��`/
ADDREss 933 Maxson d ^ CONNECTION DATA
CITY Monte TEL. NO. 444-2020 STATION �y' DEPTH F i
STATE LTI C-I'T MANHOLE REFERENCE ( 1- J UPPER
LICENSE NO 129 70 S, CLAsS 2 O h (� L / C'V L /2�"D' LgffR
NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
1 MOUSE SEWER CONNECTING TO oo CURB M.L.TO P.L. �� I a
PUBLIC SEWER 0 $5.00
SEPTIC TANK.SEEPAGE PIT OR �P.C.NO. /} / O
PITS ANO/OR GRAINFIELD C° s'OOO CO.IMP. NO. JOB NO. LJ CJ C.
v
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O:
PRIVATE DISPOSONAL BEM MV .SENEX E3.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT RECORD, INSTR,NO. DATE 0
WORK TO MOUSE SEWER E3.00
OVERFLOW SEEPAGE PIT,GRAINFIELD W
EXTN..CESSPOOL.DRYWELL.MANHOLE 0 $5.00 a
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING VI
SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS _PERMIT S z 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS /
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIG NATU RE
SIGNED THIS DAY OF 19_ /�j ('
OWNER OR NEW HOUSE SEWER C
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK,SEEP.PITIS)
HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION gND/OR GRAINFIELD
AND STATE THAT THE ABOVE IS
CORRECT AND LAGRE
AWS E COMPLY
WITH ALL COUNTY RS.ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ pRYW ELL ❑
HEREBY CERTIFY THAT I AM PROPERLY REGIS ERED ANO/OR M(-ICES5POOL5
IR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF 05AL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO PLUG AND
RESIDE IN, THE ABOVE DE$ RIBED RESIDENTIAL ROPE TY. USE SEWER
SIGNATURE PTIC TANKS ❑OF PERMITTEE ❑ CESSPOOLS ❑
C-*VALIDATION JACK R. ALLEN
l/CCKK. / M.0. CASH SUPERVISING MECHANICAL ENGINEER
Li 636300 SEI 6 O A 7.00