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Home My Public Portal About4852 DOREEN AVE_Sewer__ S . O &E6APPLICATION FOR PERMIT 1 5eDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Englaeer County of Los Angeles BUILDING J JOHN A. LAMBIE, COUNTY ENGINEER ® DRESS CASSATT 0. GRIFFIN. SUPT of BUILDING LOCALITY FOR APPLICANT TO FILL`IN L ceoss sT.LEGAL / DESCRIPTION LOT NO. Q S 2.a�7�iOWNER BLOCK TRACT f 6 S MAIL ADDRESS 'C/L`77"L a NO. OF SIZE OF LOT-3 Z!i/ 170 NOW ON LOTS CITY � TEL. N0. USE OF /v DISTRICT NO. GROUP MAP BUILDINGS T CONTRACTOR BK PG ADDRESS - - CONNECTION DATA v CITY TEL. N0. STATION DEPTH UPPER MANHOLE REFERENCE ❑ STATE � LOWER REGISTRATION NO. ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ S 3.50 SEPTIC TANK,SEEPAGE PIT OR PITS"WOR DRAINFIELD [q S 3.DD OVERFLOW SEEPAGE PIT. DRAINFIELD - P. C. NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ 51.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT HOUSE OEWER G.OR STATE ENCROACHMENT WORK C HOUSE SEWER 51.00 111 06 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ 51.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT y 100 AUTHORIZATION TOTAL FEE �� REIM BURSE M1I ENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS.- DATE INSPECTOR'SSIGNATURE DESCRIBED TRACTOR CONNECT THE ABOVE' DES CRIBEO EXISTING DW ELLIIJG TO THE PUBLE LIC SEWER. NEW HOUSE SEWER' / SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP. PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT HO PLUGAUSE D CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ER DESCRIBED RESIDENTI P OPERTY. BACKFILL SEPTIC TANK$❑ SIGNATURE ///y SEEP. PIT ISI ❑ CESSPOOLS❑_ OF PERMITTEE 2A GAe� `-"-- JOHN A. LAMBIE. COUNTY E GINEER ,i(T;gLIDATION ROBERT A. WOOD, CHIEF PLec. INSPECTOR K. N.0. CASH A;�o 1 3 0 61 F 10 4 2.00 p J6A6y20 s c B.esa Ix.sa APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer " County of Los Angeles ODD ENSG�b/ WM.J. FOX, COUNTY ENGINEER ADDRES CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST �n I✓FtP ®NI/fs9 .LIEGA I /'� /� CROSS T. DESCRIPTION LOT NO.Sa VT/"1 yX OWNER I 9 BLOCK TRACT - MAIL L/� �� 4 UU ADIPES$ J !fes �• SIZE OF LO��y,��A^ / NOW ON LOTS_ CIT f G A TEL. N USE I • e BUILDINGS pISTB7CT N0. GROUP MAP I BK_�P� CONTRACTOR ��'/l L ADDRESS�SCONNECTION DATA CITY 6\0T TEL.NO. STATION DEPTH (� ❑ STATE A M 6 FEREN CE REGISTRATION NO. ❑ COUNTY UPPER TYPE NECTi Ot LENGTH FROM O No. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L. HOUSE SEWER CONNECTING TO PUBLIC SEWER 5 3.50So HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. 13•G ' JOB. NO. _ WORK TO HOUSE SEWER 1.00 1r ✓ ALTER REPAIR EXISTING ^` SEWER O OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N0.^194 L r �V� DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT ANO/ON 013P054L SYSTEM L00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR INDUSTRIAL PITS AND/OR DRAINFIELD 2.00 WASTE APPROVAL CESSPOOL- DRYW ELL SPECIAL CONDITIONS ONLY 2.00 -- CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT S 1 00 AUTHORIZATION TOTAL FEE 4. O REIMBURSEMENT FEE I HAVE. THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE THE PUBLIC Si SIGNED THISS !DAY OF� NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING D TION WORK SEPTIC TANK, SEEP. PIT(S) ADDRESS SEPTIC 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. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ ` SEEP. PIT(,) [3CESSPOOLE G jV SIGNATURE OF PERMITTE !/:/ WILLIAM J. FOX. COUNTY ENGINEER VALIDATION OAK ��3 9 3 2'; MAY 19 4 4.5 0 ` By BY — - DEPUTY DEPUTY BY BY I ® DEPUTY DEPUTY