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HomeMy Public PortalAbout5009 DOREEN AVE_Sewer__ e � C 16804E 0.52 LE808 -6B"' 'APPLLICA6riiN FO PERMIT '" la COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER - BUILDING AND SAFETY DIVISION BU ILDING OQ ADDRESS TORN A. LAMBIE, County. Engineer R. CASSATT D. GRIFFIN. Sup t of Building LOCALITY _ NEAREST y FOR R APPLICANT TO FILL RQ cRDss sT O LEGAL S' OWNER B56CRIPTION LOT NO. i TRACT 3 - MAIL ADDRESS N0.0 BLDGS. O SIZE OF LOT .S NOW ON LOT CITY TEL. N0. -USE DI DISTRICT NO. GROUP MAP ROCESSED BY .BUILDINGS _ - _ d 8 L I SPG CONTRACTOR - I- ADDRESS © - CONNECTION DATA CITY t• ^TEL.NO. A _ STATION .13 '- -[� DEPTH ^/ .._JJQ V COUNTY N OLE REFERENCE UPPER BEGISTRADES N0. Lp No. DESCRIPTION OF WORK FEE USE SEWER CONNECTING TO PUBLIC.SEWER @ $3.00 LENGTH TYPE by. CONNECTION H FROM SETSAAND/OR SEEPAGE E PIT OR @ $3.00 Y. CURB P.L. ENGT P.L. - OVERFLOW SEEPAGE PIT, DRAINFIELD Of EXTN.. CESSPOOL.DRYWELL @ $2.00 HOUSE SEER CONNING PRIVATE DISPOSAL SYSTEM TO @ $1.00 CO.IMP. N0. JOB NO. ✓ e_1 3 t� CONNECT ADDITIONAL BLDG.OR WORK TO'HOUSE SEWER @ SI.00 TRUNK PERMIT N0. -ROAD PERMIT N0. _ ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. JNDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMT $ 2 00 CONNECTION CHARGE FEE" ,AUTHORIZATION TOTAL FEE F X5 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 - 19_ NEW HOUSE SEWER 10 IV3- OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK " ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD- _ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL I]- DRYWELL E) ITH 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 'REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWN OF THE ABOVE DESCRIBED RESIDE TIAL PRO RTY. BACKFILL SEPTIC TANKS ❑'" SIGNATURE SEEP. PIT(S) El CESSPOOLS El OF PER MITTE / ®• ALIDATIOROBERT-A. WOOD LE. M.o. c,sH SUPERVISING MECHANICAL ENGINEER, LAG 2 1 1 2 2 arts 13 1. 0 a 5.00 M l�fJ�GY7�!y✓ ' . , TEMPLE CITY ape°a° cAPPLICATION- FOR PERMIT ceoa e1EY COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER _.. BUILDING AND SAFETY DIVISION. BUILDING ;. IGRN A. LAMBIE, CouolF Engina°c A.DDRESS CARSATT D. GRIFFIN, Supt of Boildiag LOCALITY NEAREST FOR APPLICANT TO Fn IN Cnoss s . LEGAL c DESCRIPTION LOT N0. / /r pJ OWNER / BLOCK TRACT MAIL � ADDRESSNO.OF /y SIZE OF LOT NOW ON LOTSg�ST2 ITY L NO. T L/ USE OF BUILDINGS DISTRICT N0. GR MAP�yP PROCESSED BY CONTRACTOR ✓ADORESS D Y IOCONNECTION DATA CITYy EL.N0. TATION J EPTH t, H ERENCEREGISTRATION N0. /�DST `� LOWERNO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ 43.00TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PITOR . CURB P.L. M.L.TOP.L.PITS AND/OR DRAINFIELD @ $3.00OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP.C.N0.PRIVATE DISPOSAL SYSTEM @ SI.00' O.IMP. NO. JOB NO.WORK TOT HOUDSEISEWER LOG.OR @ St.00RUNK PERMIT NO. ROAD PERMIT NO. I Lc N� ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ S1.00 PERMIT NO. / 1 / INDUSTRIAL {� O WASTE APPROVAL 1(,R�VMn PIv I CHARGES AvwN.N .\N d.l. OWNM'S PERMIT $ I CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I� I / w A� 1 HAVE AT THIS DATE A CONTRACT WITH.THE HEREIN NAMED CON- ' 1^' if 11 1p ' TRACTOR TO CONNECT'THE ABOVE DESCRIBED EXISTING DWELLING ]BANDON APPROVA AI�'I DATE (NS CT R IGNATUAE TO THE PUBLIC SEWER. �y SIGNED THIS DAY OF 19_ OUSE SEWER 4U'- X /t OWNER A ECT ADDITIONA /r OWNERS AGENT ING OR WORK f ADDRESS C TANK,SEEP. PIT A/,/ R DRAINFIELD /N� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ,1/• AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY OOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING .REPAIR.SEWER OR PLUMBING AND SEWERS. E DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR NNECT PLUG AND P LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 00N HOUSE SEWERCALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVEDESCRIBED RESIDE IAL PROP RTY. ILL SEPTIC TANKSSIGNATURE PIT(S) ❑ CESSPOOLS OF PERMITTE ®F ALIDATION--­, ROBERT A. WOOD CK. M.p. pAp SUPERVISING MECHANICAL, ENGINEER' LAC0 2 1 1 32 JU?! 1 j 1 1 D 25.00