HomeMy Public PortalAbout5336 BUTTONS AVE_Sewer__ :.76"E APPLICATION: FOR PERMIT
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'-DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depoximent of County Engineer
` County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER AD ORc'SSP 7
CASSATT D. GRIFFIN, SUPT oP BUILowc LOCALITY Ar-
FOR.APPLICANT TO FILL IN NEAREST �t
CROSS IT.
LEGAL
DESCRIPTION LOT NO. OWNER �,7� �L^G
BLOCK TRACT ` / A DRESS !"" low
Ic
X-50NO. OF BLOTS. +/
SIZE OF LOT NOW ON LOT CITY TEL. N0.
USE OF / y X
,U'
LOINGS �_O�• // DISTRICT N0. GROUP MAP
PG
CONTRACTOR C{� ' `-�., S I?KT J/ q
ADDRESS s '� �,% CONNECTION DATA r
CITY ���Z�P t���` TEL. N0. � mp.� QQ'
r gr_'� STATION / O OEPTN (p .0
+��_ - (] STATE ` c MA EFEREN CE
REGISTRATION N0. Fl S L/ ��y ""'TY 9 /-q .J PPER'/
TYPE OF'CO NECTION LENGTH FT
NO, DESCRIPTION OF WORK FEE P. 1.L.TO P.L. b
HOUSE SEWER CONNECTING TO 3 M
PUBLIC SEWER (<V $ 3.50 J
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT HOUSE ONALSEWER
BLDG. OR CO. IMP. NO. JpBriIQ , 7
WORK C HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00 TR RMIT N0, ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE EN CROA T
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR -
_ PITS ANO/OR DRAIRFIELD 2.00INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CH E FEE
OWNERS PERMIT 1 00
AUTHORIZATION TOTAL FEE REIMBUR' RENT FEE
,I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ATE INSPECTOR'S SIGNATURE
THE PUBLIC SEWER
SI NEW HOUSE SEWER
�1
SIGNED THIS DAY 19_
OWNER � CONNECT ADDITIONAL
AGENT
OWNERS AGENT �r�/�.—/c BUILDING OR WORK
�j SEPTIC TANK. SEEP, PIT(S)
ADDRESS ANO/OR DRAINFIELD
f
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL C3DRYWELL❑
AND STATE THAT THE ABOVE ICORRECT AND AGREE TO AT
WITH ALL COUNTY ORDINANCES
S AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY F STATE OF DISCONNECT USE PLUG AND
CALIFORNIA SI THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) E7 CESSPOOLS❑
SIGNATURE
OF PERMITT _
WILLIAM J. FOX, COUNTY ENGINEER - VALIDATION .
BYLIGo5B140APR 16 4 4.50
DEPUTY - DEPUTY
..-ABY BY
��® DEPUTY EPUTY
CE808 3-64 , - 'A
76A6420 APPLICATION FOR PERMIT [/�1
,I
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL IILIII
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 333, T7.C/✓s A v G'
JOHN A. LAMBIE. County Engineer ADDRESS
WILLIAM A. JENSEN, Supt et Building -- G
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CRGSS ST. / 'V Jr
LEGAL /v1j_ L/74tit
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT 2. a ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS
PG
DISTRICT NO. GROUP MAP PROCESSED BY
{ BK
CONTRACTOR II/A/ "v/ �V
ADDRESS O(- /J 1,C��' / CONECTION DATA
CITY TEL. NO. 9 4/ '3 STATION DEPTH
STATE UPPER
REGISTRATION RI /
COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WO K FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO I Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER ® 55.00
SEPTIC TANK,SEEPAGE PIT OR P.C.N°. `r
PITS AND/OR GRAINFIELD @ SIO.00 CO.IMP.NO. JOB NO. OL
HOUSE SEWER CONNECTING TOTRUNK PERMIT NO. ROAD PERMIT NO. O
PRIVATE DISPOSAL SYSTEM 33.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT (p 4z[I([xi RECORD. INSTR.NO. DATE a
/ W ORK TO HOUSE SEWER 33.00 O
OVERFLOW SEEPAGE PIT.GRAINFIELD H
tXTN,.CESSPOO1_.ORYWEL1_,MANHOLI5 35.00
ALTER,REPAIR OR ABANDON HOUSE V.OR 5 N G 6
SEWER OR GIBPOSgL SYSTEM ® 53.00 STATE ENCROACHMENT
PERMIT NO, Z
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ z 00 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 DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERSAGENT CONNECT ADDITIONAL
ADDRESS •BWLDTRCL IRWOR K 3 V/IiJra)a• /
SEPTIC TANK,SEEP.PIT(S) ( •F
IH
ACKNOWLEDGE THAT I HAVE REAM THIS APPLICATION ANDf OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU Me ING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY 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 DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE (/ BACKFILLEEPTICTANNS ❑
OF PERMITTEE Al��/1/� ��J�i
SEEP,PIT(S) ❑ CESSPOOLS ❑
OVALIDATION ROBERT A. WOOD
CASH
M. SUPERVISING MECHANICAL ENGINEER
CK. O.
LAC 2 0.2 1:o VIM 26 1 0 0 5.0 C