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HomeMy Public PortalAbout5132 DALEVIEW AVE_Sewer__ 0EB0B3-62 APPLICATION FOR PERMI� TBAGazo COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DIS OSAL BUILDING AND SAFETY DIVISION BUILDING JOIN A. LAMBIE, County Engineer ADOflsss CZ //tiQ—L WILLIAM A. JENSEN, Suping t of Buildy �C LOCALITY / NEAREST FOR APPLICANT TO FILL IN GROBB ST. EGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF SLOGS. Q) SIZE OF LOT NOW ON LOT % CITY TEL. NO. USE OF BUILDINGS _ . U DISTRICT NOGROMAP PROCESSED BY USE _ LLV_V /l 'K PG /1 CONTRACTOR `J `� � © L. G _ P ��// z ADDRESS '3 7/ CONNECTION DATA CITY TEL. NO. L_' �CO Q STATION ?�_ DEPTH 3 REGISTRATION NO. Gi ® STATE MA NHOLE REFERENCE COUNTY / LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECT LENGTH FRO J HOUSE SEWER CONNECTING TO A./'1 Y. CURB P.L. M.L.TO P.L. E} PUBLIC SEWER @ $5.00 V ✓ o SEPTIC TANK.SEEPAGE PIT OR P.C.NO. V PITS ANO/OR DRAINFIELD 310,00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.PRIVO CONNTE ECT DDITILSYBTEM $9.00 CONNECT HOUSE SEW BLDG.Ofl AFFIDAVIT 11V[II �SEMEMI RECORD.INSTR.NO. GATE 3�WJ WORK TO HOUSE SEWER $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD ALTER,REPAIR OR ABANDON HOUSE Q $3.00 �yy ALTER,REPAIR OR ABANDON HOUSE HWY. OR$T.WIDENING L SEWER OR DISPOSAL SYSTEM ® 33.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT s z 00 CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS OATS A CONTRACT WITH THE HEREIN NAMEO COLN,. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS GATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNEHS AGENT / Jt^� CONNECT ADDITIONAL ( H BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION gNO/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT 1 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 I M THE LEGAL OWNER F. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE LURIBED RESIDENTIA PROPERTY. ABANDON HOUSE SEWER n SIGNATURE ❑ OF PERMITTEE BACKFILL SEPTIC TANKS SEEP.PIT ISI ❑ CESSPOOL4 [a G i V VALIDATION ROBERT A. WOOD CK. M.0. �� SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH lrtCD 0 4 3 4 G Jnrl j 1 1 0 D 7.0 0~ m D PART31FNT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL vY DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES �f WILLIAM .1. FOX. COUNTY ENGINEER I BUILDING -32 ADDRESS'S/� FQR APPLIC4QT TO`FILL IN;' LOCALITYC� BUILDING G Y' EA .NEAREST � �C ADDRESS �/ G:AY/ CROSS ST. C� LOCALITY DISTRICT N0. /, SERIAL N0. PERMIT NO. C WEAREST A _ „ �� �D 7/J CROSS ST. ,,. 6► RECEIVEDABY r Ready for Inspection 0 '7E IISSSSUE OWNER _ .MAIL �:1.Jy^• w •-, LFL. / ADDRESS' I`� A 0,LF V I Lfb✓ SE ZON I 1,6 OCCUPANCY BK MRCP PS CITYL �Jv .NO. O w7I ��- - sa CONTRACTOR .�' • r CO.IMP.NO. ADDRESS -�!. 1 .�A A L JOB.NO. CITY ` L OJ - ti• TRUNK PERMIT N0. " �•[] STATE REGISTRATION/NO. _,1 . '.�B COUNTY ROAD PERMIT NO. LEGAL Y t �"} - STATE ENCROACHMENT DESCRIPTION LOT N0. L/,V PERMIT NO. BLOCK TRACT //y O ZO INDUSTRIAL y y f WASTE APPROVAL SIZE OF LOT, ®� NOW ON LOTNO.OF S I CI ARGES USE OF BUILDINGS OO" IAA' . CONNECTION CHARGE FEE NO. DESCRIPTION OF�WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 HOUSE SEWER CONNECTING TO 3 3.50 RECEIPT NO. / DATE IBY PRIVATE DISPOSAL SYSTEM 1.00 G CONNECT ADDITIONAL BLDGIORE CEPTIO RECORDED WORK TO HOUSE SEWER 1.00 _ ALTER OR REPAIR EXISTING NO. I DATE IBY SEWER OR DISPOSAL SYSTEM 1.00 / .DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CO�NECTjell DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION . DEPTH CESSPOOL—DRYWELL ' SPECIAL CONDITIONS ONLY 2.00 Z O - MAG DLE REFERENCE PPER LOWER , TYPi OF CONN EG O! LENGTH FROM OWNERS PERMIT f I 00 V. CURB . L. M.L.TO P.L. AUTHORIZATION TOTAL FEE D 1 HAVE THIS DATE CO RACTED WIT NE HEREIN NAMED HAVE TO CONNEC THE ABO DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE DWELLING TO THE PUBLI -EWE SIGNED THIS...�.�. .. NEW HOUSE SEWER OWNER OR s CONNECT ADDITIONAL OWNERS ACy�jJT... .... _- • N'. ........ • BUILDING OR WORK `` SEPTIC TANK,SEEP.PITS) ADDRESS...a/.�_$... .. .. ......_....._..� 9.._A`".�-.._......_. AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE R AD THIS APPLI- CESSPOOLd'OBYWELL � 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COJOWNV ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL ER OF THE ABOADRIBEDAOR RESIDENTIAL PROPERTYBACKFILL SEPTIC TANKS({AJ A� SEEP.PIT(S)Q CESSPOOLS 0 SIGNATURE IFh'•r�'C.+._.OFPERMITTEE_. s . .... ._._._..._ 76AG42A 663. 4/53