The URL can be used to link to this page

Home My Public Portal About9170 CAMINO REAL AVE_Sewer__ 80 CEAPPLICATION FOR PERMIT eo811-s� COUNTY OF LOS ANGELES5 SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer I NEAREST ADDRESS CASSAIT D. GRIFFIN, Supt of Building LOCALITY FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER BLOCK TRA - MAIL ADDRESS 1TO.OF BLOGS. SIZE OF LOT NOW ON LOT CITY TEL.NO. USE OF BUILDINGS DISTRICT NO. I - GROUP MAP BK PG CONTRACTOR 7 _ r�........ _. ADDRESS CONNECTION DATA CITY TEL.NO. - STATION DEPTH REGISTRATION NO. - STATE COUNTY MANHOLE REFERENCE UPPER j LOWER NO. 1 DESCRIPTION OF WORK FEE f`.,:,_... HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.5 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 EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO. CONNECT ADDITIONAL BLDG.OR I WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 1 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 1 9 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE - _ SEEP.PIT(S) ❑CESSPOOLS ❑ OF PERMITTEE OF VALIDA'T'ION ROBERT A. WOOD CK. ►1.0. CASH SUPERVISING MECHANICAL ENGINEER APPLICATION FOR PERMIT 1 DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL D.pa rbmx t of Cott Enpia..r Co>tnfp of Los Angelms BUILDINGFESS JOHN A. LAMBIE,COUNTY ENGINEER CARSATT D. GRIFFIN. SUPT OF BUILDING LITY III EAREST FOR APPLICANT TO FILL IN CROSS STET. LEGAL Q•R Elt DESCRIPTION LOT NO. - RAIL ,�... BLOCK TRACT ADDRESS NO.Of BLDGS. CITY >—Y TEL. N0. SIZE OF LOT 04 XON ON LOTS USE OF ' DISTRICT N0. GROUP IAP BUILDINGS •Y' B[ PG CONTRACTOR L ADDRESSCONHE=ONN DrAT STAn 0 X D HPTH CITY TEL N0. RANHOLE REFHRENCY ATH ' LOWER REGISTRATION 0. a ❑ COUNTY r No. DESCRIPTION OF WORX FEE HOUSE SEWER CONNECTING TO ,ti TYPE OF C B ION LENGTH FROr Y. CURURB P.L Y.L.TO P.L PUBLIC SEWERS.SO ' SEPTIC TANK,SEEPAGE PIT OR - PITS AMD/OR RRA XFIELD @ S 3.00 OYERFL W SEEPAGE PIT,DRAINFIELD P. C,X0. EZTN.,CESSPOOL DRYWELL MANHOLE ® 2.00 CO. IMP. N0. JOB N0. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® S 1.00 TRUNK PERMIT NO. ROAD PERMIT X0. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT - WORK TO HOUSE SEWER @ S1.00 PERMIT X0. ALTER,REPAIR OR ABANDON HOUSE AIDUSTRIA{{.. - - SEWER OR DISPOSAL SYSTEM 1.00 WASTE AFPkOYAL CHARGEE CONNECTION CHARGE FEE OWNERS PMUT S 1 00 AUMORIZATION TOTAL FEE cREIreuRsErENT FEE I HAVE AT THIS DATE A CONTRACT WITH THEHEREIN NA ED COX- APP$OVAI$ DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED ERISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEVER SIGNED THIS IIAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK, OWNERS AGENT SEPTIC TANK,SEEP,PITIS) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. JEWAGE DISPOSAL SYSTEM _ I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR - LC EXSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE ABA DO HOUEH SEWER DESCRIBED RE-31DEITIO PROP TY. BACKFILL SEPTIC TANKS❑ SIGNATURE • r • SEEP.PIT(3) CESSPOO '.� I:S�Z.. OF PERMITTEE JOHN A. L.AMBIE, COUN ENGINfHR U AIMATION ROBERT A. WOOD, CHIP PLBG. INSPECTOR [. Y.G. CASH - LAP ,01 6sR 4 4 A 4.50 4