HomeMy Public PortalAbout9000 CALLITA ST_Sewer__ CEBG83..62 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES . SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION W.DD
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.JOHN A. LAMBIE. COUNTY ENGINEER .!.
COLEMAN W. JENKINS. SUPT. OF BUILDING �, Q
LOCALITY L-
FOR APPLICANT TO FILL IN .
lyd
EGAL
DESCRIPTION LOT NO.
/)//ABLOCK TRACT SalNO. OF BLDGS. ISI2E OF LOTNOW ON LOT TEL. NO.
USE OF —� �1 I DISTRICT NO. GROUP MAP 0CESSED BY
BUILDINGS LAl a
BK PG
CONTRACTOR �� �I N 'I � G
ADDRESS (` p c / C Zlq Z- 11F CONNECTION DATA
CITY TEL
NO. /� STATION 0,9L DEPTH -7�
-Y/
STAT ) MANHOLE REFERENCE
LICENSE NOSEJ CLASS
NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH F OM
HOUSE 5EWERCONNECTINGTOqp Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER SE.00 SOV
SEPTIC TANK.SRAINFIELD EEPAGE PIT OR JO NO O
CO.I.P.NO. I JOB NO. v
PITS AND/OR D � f10.00
HOUSE SEWER CONNECTING TO I TRUNK PERMIT NO. ROAD PERMIT NO. K
PRIVATE DISPOSAL SYSTEM AD $3.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 1 1*1111 1411"t4l RECORD.INSTR.NO. DATE r
WORK TO HOUSE SEW ER 13-00 (J
OVERFLOW SEEPAGE PIT.GRAINFIELD IL
EXTN..CESSPOOL.DRYWELL,MANHOLE@ SS
.GO
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
_ SEWER OR DISPOSAL SYSTEM @ $3.01 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WA5TE APPROVAL
CHARGES
OWNERSI PERMIT Sl zI 00
AUTHORIZATION TOTAL FEE oQ 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
TO THE PUBLIC SEWER. APPROVALS A3X INBP CTOR'S SIGNATURE
SIGNED THIS DAV F 19_
OWNER OR EW HOUSE SEWER f(
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP.PIT(S)
I H EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING [3PLUMBING AND SEWERS. CESSPOOL C3DRYWELL
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT AM TME LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS El / ` p
OF PERMRTEE _ SEEP.PITIS) [ICESSPOOLS- IA' IGS Vc�� •._�f
VALM.0. ( 7ASH JACK R. ALLEN
U/ SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
IM
[_fil,o 5 i 3 9� J17111 2 0 1 0 A 7.0 0"
DEPART3fENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TSO FILL INLOCALITY
BUILDING /1 !, 7��. NEAREST /✓ �J ,, /J
ADDRESS y /1 d-n(� Y DA.fJ CROSSST. �ILT�aM�--r-o—
5
LOCALI � Yi ��P DISTRICT NO. SERIAL NO. PERMIT N0.
NEAREST �
CROSS ST.
Q4 , f- .� FRECEIVED( BY 'Ready for ineoectinn DATE ISSUED
-OWNER-._ AI\i\ /✓✓/ if SG A 8 -
MAIL
ADDRESS// SIR/ -� USEZONE OCCUPANCY MAP
PG
/ /
CITY V TEL.NO. e v
CONTRACTOR / A��(/n /M�11- _CO.IMP.NO.
ADDRESS yr Pl ei S� T I MA N' JOB.NO.
� 36V'TEL.NCO-'1/V]Tq�/,�� �E TRUNK PERMIT NO.
REGISTRATION x C �IX® COU NT r'
ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER 0 $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE IBV -
SEWERORDISPOSALSYSTEM 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 DEPTH
CESSPOOL—DRYWELL �. b� MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY 2.00
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ I I GO
AUTHORIZATION I TOTAL FEE I —�, D
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING ! APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS----..—.-------DAY OF----_---,_..._.__.._.-.____19_._ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.....-.,..._------_. _ - BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS---------------_.._...._...._------------................_..._...._._._-,...._.._. ANO/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL` DRYWELL f(^I('rn,�•�'� `I l�I
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 DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED By LOS ANGELES COUNTY
AND STATE OF CALIFPR.N4A OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE D C BED QE IDENTIAL PROPERTY. BACKFILLSEPTICTANKS
SIGNATURE (// �� //// _ SEEP.PIT(S)Q CESSPOOLS
OF PERMITTEE...,,. .._______.. ._ ._ _1-------�'------% 1
i6A0Q2A 063 i/53_ I Ur pry�Vt/IL'% �..1.