HomeMy Public PortalAbout5130 DALEVIEW AVE_Sewer__ CE808 3 62
7GA642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING / a t C`
IDNN A. LAMHIE, County Evginevr ADDRESS
WILLIAM A. JENSEN. SuP t of Building
wcqurr C
NEAREST
FOR APPLICANT TO FILL IN `ROSS ST.
LEGAL
DESCRIPTION LOT NO. AA/ D OWNEfl ,.GC
MAIL
BLOCK TRACT / y (/ L., CT/> ADDRESS
f— NO. OF BLDG5. I�
SIZE OF LOT NOW ON LOT ( CITY TEL. NO.
USE /I /[ / DISTfl ICT NO. Gq0 MAP PROCESSED BY
BUILDI.I NGS
PG
CONTRACTOR '/ �/ • Y / ���� T�
ADDRESS �A ]fl, p(/jJ� CONN/ECTION DATA
CITY TEL. No /J �r G d ION DEPTH
S /
TE L, PP
�J ❑ MANHOLE REFERENCE
'
REGISTRATION NO. 1J � � � � ❑ COUNTYATI
NO. DESCRIPTION OF WORK FEE T PE OFC }J NE 1 LENGTH .L >
OM / Y
HOUSE SEWER CONNECTING TO Y. C .L. M.L TO
PUBLIC SEWER @ 55.00 ` P.C.NO. Vim[
SEPTIC TANK,SEEPAGE PIT OR I CO.IMP. NO. / 3� JOB NO, U
PITS AND/OR GRAINFIELD SID,DD
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O
PRIVATE DISPOSAL SYSTEM @ S3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 11Y .[[[MEX RECORD.INSTR.NO, OATIE
WORK TO HOUSE SEWER a 53.00 �OWJ
OVERFLOW SEEPAGE PIT.DRAINFIELD
E%TN.,CESSPOOLDRYWELL.MAN XO LE $5.00 VJ
ALTER.REPAIR OR ABANDON HOUSE H WY.OR BT.WIDENING Z
SEWT,OR DIS OSA TL' M 53.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT s s� ECTION F E c G
CHARGE
' AUTHORIZATION TOTAL FEE � J--`Z>�� ONN
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR
TO CONNECT TME ABOVE DESCRIBED E%ISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGNATURE
SIGNED THIS DAY OF 19_
OW HERON /� NEW HOUSE SEWER
OWNERS AGENT_(��_ "/ CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP, PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION A ND/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRVWELL ❑
IHEREBY CERTIFY THAT I 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 1 AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUO AND
RESIDE IN, THE A V DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERM
RTEE BACKFILL SEPTIC TANKS
SEEP.PIT 15) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK. M.0.
SUPERVISING MECHANICAL ENGINEER
CASH
LIDO0 4 3 3G Jf%Pl31 1 1 D 2 5.00- m
"808382
Tsasaz0 APPLICATION FOR PERMI t/
lJ
COUNTY OF LOS ANGELES SEWER—SEWAGE.DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Eegineer ADDRESS d
WILLIAM A. JENSEN, Supt of Building C
LOCALITY
NEAREST n
FOR APPLICANT TO FILL IN RGEs
LEGAL
DESCRIPTION LOT NO. OWNER
�J MAIL
BLOCK TRACT J L.� O ✓ ADDRESS
NO. OF BLDGS. (Y)
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF A/tf
BU ILOINGS Iff^" - DISTRICT"NO. R. MAPPROLES EO BY
CONTRACTOR (r I 0
CONNECTION DATA
_`C
ADDRESS
CITY TEL. NO, ~ ('I ION O DEPTHKr
G' STATE MANHOLE REFERENCE I1PPE
REGISTRATION NO. COV NTY q y
NO. DESCRIPTION OF WORK FEE TY OF CO ' CT N LENGT FROM a
HOUSE SEWER CONNECTING TO ` Y, R P M.L.T P.L.
@ O
PUBLIC SEWER SSO. J
SEPTIC TANK.SEEPAGE PIT OR 1 JOB NO.
3� NO.
PITS AND/OR DRAINFIELO @ $10.00 CO.I.P.NO, p AOR V
HOUSE SEWER CONNECTING TO /y
TRUNK PERMIT NO, ROAD PERMIT NO, y
PRIVATE DISPOSAL SYSTEM @ 53.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT W/.IVEqSEMEN RECORD.INSTR,NO, DA'r.
WORK TO HOUSE SEWER @ S3.00
OVERFLOW SEEPAGE PIT,GRAINFIELD a
.E%TN.,CESSPOOL.DRYWELL.MAN.OLE@ S,O. y
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING L_
SEWER OR DISPOSAL SYSTEM @ 53.00 _ STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WA TE APPROVA
OWNERS PERMIT f z oo _ E£�"
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
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGN TV RE
SIGNED THIS DAY OF 19_ /f �--✓
OWNER ORA/) NEW HOUSE SEWER pl
OWNERS AGENT / l CONNECT ADDITIONAL / y
DRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(S)
1 HEREBY ACKNOWLEDGEABO THAT HAVE HEAD THIS,ATO CO TION pNO/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE E LATING
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL ❑
I HEREBY CERTIFY THAT I 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 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG ANO
RESIDE IN, THE AB VE DESCRIBED RESIDENTIAL PR ERTY. ABANDON HOUSE SEWER
BIGNAT... ❑
OF PERMITTEE BACKFILL SEPTIC TANKS -
SEEP,PITISI ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK. M.0. /\.ASH/I
/ SUPERVISING MECHANICAL ENGINEER
/
LrlLo 0 4 3 2 JAN 1 1 0 D 7.0 0~ v