HomeMy Public PortalAbout5220 DALEVIEW AVE_Sewer__ DErnWrmFNT OF COUNTY ENGIINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER, I ADDRBUILDING ��•� ^
ESS ✓ �f
NEAREST
FOR APPLICANT TO FILL INIOCALITY C,
BUILDING SA n O � rQJI�•�TJC/WROSS ST.ADORERS 2LOCALITY � � DISTflICT N0. 8ERIAL N0. tPERMIT N0.
NEAREST O A l ��O S
CROSS Si. 1 �� -}– RECEIVVEEDByReady for Inroaatlen DATEEISS ED-
CWNER �/fQY/H -
ADDMAI ®fin i� USEZONE OCCUPANCY MAP
ADDRESS iQ�.1/)�,( BK – PG
CITY TEL.NO. / ILC'iW'c
CONTRACT ✓
qll r. Nottingfiam Ce of temple City CO.IMP.N0.
ADDRESS 5933 N. CLOVERLY AVE. JOB N0.
CITY TEMPLE C}V-pMLIF.
TRUNK PERMIT N0.
�1 f� A ❑ STATE
REGISTRATION N0. - ("� . ' A !4 ❑ COUNTY 1 ROAD PERMIT N0.
LEGAL .C" STATE ENCROACHMENT
DESCRIPTION LOT NO. Q PERMIT NO.
BLOCK TRACT T,lr%pZ 7: INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER 0S 3.50 RECEIPT NO. I DATE 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' I DATE BY
SEWER OR DISPOSAL SYSTEM1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AHO/OR GRAINFIELD 2.00 '.STATION - - DEPTH
CESSPOOL—DRYWELL ) ��
SPECIAL CONDITIONS ONLY 2.00 L• MANHOLE REFERENCE
' UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L:
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN'NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING -
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
-
SIGNED THIS.._..__.........DAY OF..........._-.---------_------19_-_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...........................................................................,. ,BUILDING OR WORK
ADDRESS----------------------_---------..._..... __.__..__ SEPTIC TANK.SEEP.PIT(S)
......_....._.._....._.._.._.._. AND/OR DRAIN ELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL. DRYWELL E] 7L; J
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE �i�i
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR .
REGULATING PLUMBING AND SEWERSEWAGE 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 CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRI E�D RREESI�DEqTIAL PROPERTY.
'? BACKFILL SEPTIC TANKS
�
SIGNATURE
A)'7 'kYf/.YJ/[.�K!' SEEP.PIT(S) CESSPOOLS
OF PERMITTER_ ._.....--........._._.____.._..._..._...._.._...... _ . ..
76A642D 663 'Amr' tNizi
98A8d26D
APPLICATION FOR PERMIT
5&S4ILS9.
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE' DISPOSAL
Department of County Engineer / .. - - -
County of Los Angeles' i BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS r
F7 CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ADDRESS _
'y . OF BLDGS. CITY TEL. N0.
SIZE OF LOT r� OW ON LOT
USE DI DISTRICT NO. GROUP MAP
BUILDINGS tai
CONTRACTOR Nick S Hidek < Y -- `BK /Pl'�V
CONNECTION DATA
ADDRESS Td 8
3995 PPEnn Phare �] ..cc
CITY; El onte TEL. NO.GI —28 STATION L !0: DEPTH
H
L MANHOLE REFERENCEUPPER,/
149595 Y STATE �< LOME*
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION '. LENGTH FROM y
_ PUBLIC SEWER @ 5 3.50 0 Y. CURB .L. M.L. TO P.L. Z_
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ 53.00
OVERFLOW SEEPAGE PIT, DRAINFIELD - `7 P. C. NO.
EXTN..CESSPOOL,DRYWELL,MANHOLE C S 2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ 51.00 TRUNK PERMIT NO. ROAD PERMIT N0,
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM - @A $"Go WASTE APPROVAL
CHARGES
1
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
' APPROVALS DATE INSPECTOR'S SIGNATURE
I HAVE AT THIS GATE AHCONTR ACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWERi
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR �j _/ BUILDING OR WORK
OWNERS AGENT 1 f�-!�(J� r Oh-I""
SEPTIC TANK.SEEP, PIT(S)
ADDRESS ANO/OR DRAINFI ELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS-. SEWAGE DISPOSAL SYSTEM
-1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS RECURRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HO PLUGUSE D
CALIFORNIA OR. THAT I AM THE LEGAL OWNER OF THE OVE ,
DESCRIBED RESIDENTIAL PROP TY. BACKFILL SEPTIC TANKS❑ �yI
SIGNATURE SEEP. PIT(S) Ll CESSPOOLS LO 1�{Syyl
OF PE11,RMITTEE '�
JOHN A. LAMBIE, COUNTY ENGINEERyALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR .
CK. tl. 0. CASH
I�:Lo 8 9 2 7 v J01 6 4 4.5.0