HomeMy Public PortalAbout5026 DOREEN AVE_Sewer__ 76A6°
GAPPLICATION FOR PERMIT 1
eE.firro[� OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOB Angeles p0 REIS SG
WM. J. FOX. COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
L
FOR APPLICANT TO £ILL IN NEAR— EST
CROSS ST.
LEGAA' ,
DESCRIPTION LOT NO 13OW ��/V
INNER L � 7 /1U/6?(//Jf
BLOCK TRACT �Q MAIL �_0 p. I , �1 .O^ .I�
y ADDRESS .7Vd I I hId,'?A . I
„ / Aa N0. OF BLOCS. �'J I
SIZE OF LOT p /((/ NOW ON LOT CITY TC/"t (,NT e,/ TEL. NO.
USE OF
BUILDINGS ! V DISTRICT NO. GROUP MAP
CONTRACTOR 'L .t S & e BK P
ADDRESS ) ' �l /d b CONNECTION DATA
CITY •�///1�,�� TEL'N0. /.�r Z������ STATION DEPTH
Y lr ❑ STATE M NHOLE REFERENCE
REGISTRATION NO. "!-/ .9 B)UNTY M PPER LOWER
Y' T TYPE OF CONNECTION LENG FROM
No. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L O P.L.
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER Q S 3.SO _
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 _
/ CONNECT ADDITIONAL BLDG. OR /
IMP. N0. JOB. 0.
WORK TO HOUSE SEWER 1.00 CO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0, ROAD PER.IT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHAND/OR DISPOSAL SYSTEM 1.00 PERMIT T
N0.
SEPTIC TANK. SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APP INDUSTRIAL/
SPECIAL CONDITIONS ONLY 2.00 _I_ / CHARGES
PERMIT COI ECTION CHARGE FEE
OvRm'S s 1 00
AUTHORIZATION TOTAL FEE j/ REIMBURSEMENT FEE
I HAVE DATECON-
TRACTORTHIS 70 CONNECTD NTTHE ABOVE CTEDW EITH SCRIBED EXISTINGTHE HEREURA9E0 DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC S�AW"E(ft� (�y
SIGNED THIS-12—(If-DAY OFNEW HOUSE SEWER l�J/ /A
OWNER OR ✓` v �� • BUILDING OR WORKw CONECT AL eY/,-
OWNERS AGE/N)T
ADDRESS
,V � � �/ "� 1 SEPTICTANK, SEEP, PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS I(PPLICATIO CESSPOOL L3DRYWELL❑
'AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMP
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULAT G ALTER. REPAIR, SEWER OR
PLUMBING AND SE`NERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN ATE OF DISCONN HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE 1EG OWNER 0 ABOVE
DESCRIBED RE510ENT((I//pp✓L PRgp ER3V/ BACKFILL SEPTIC TANKS❑
JN (/{Y�✓��'%�Cys'' ` SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
d ' 31-:6 8 is APR 2 8 4 2.0 0
BY
DEPUTY DEPUTY
BY BY
® DEPUTY DEPUTY
f. °
5 ftE.6n3 Iz-ss
APPLICATIOWFOR PERMIT
o n .e
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deptamlent of County Engineer
County of Los Angeles BmcDING O
WM. J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN. SUPT OF BUILDING - LOCALITY / G�
FOR APPLICANT; TO FILL IN NEACR.REST ��
T.
LEGAL
DESCRIPTION LOT NO. DJ D !/ H/ ON/N ER
BLOCK TRACT v AIL
/I�/ � ADDRESS
NO,IOF BLDGS.
SIZE OF LOT / 1�/ //N�AOW�ON L�OT // /� CITY TEL. NO.
USE O.�ie_N/�[.�'PTiNR�-/V /�elGi/2.eEn-� DISTRICT O, GROUP BK MAP PG
BUILDINGS AJ �,
CONTRACTOR 1�� / 1 ['r�.yAi`�� ,S L 39
ADDRESS Jn�L,r,!/^„t�A�f CONNECTION DATA
TEL. NO. STATION DEPTH
1 [I STATE MANHOLE REFERENCE
REGISTRATION NO. ❑ COUNTY UPPER LOWER
- TYPE OF CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P.L. f� M.L.
TO P.L.
HOUSj SEWER CONNECTING TO S �0` '--A L-y
G/}-7-'�p !!� •1/I '
L PUBLIC SEWER Q $ 3.50 \o
HOUSE SEWER CONNECTING TO 0� 'j 1% \ �J ;i I
PRIVATE DISPOSAL SYSTEM LOB __ -f I Tf.
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. 7 JOB. NO.
_ WORK TO HOUSE SEWER 1.00 zALTER OR ��
_ I SEWER OR DISPOSAL SYSTEM PAIR EXISTING 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. .
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT,
__AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
'CESSPOOL- DRYWELL WASTE.APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
YCONNECTION CHARGE FEE
OWNF.R•S' PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THI5.,DATE.CONTRACTED WITH THE HEREIN NAIED CON.- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '/ q
THE PUBLIC SEWER
SI
SIGNED THIS ✓ � 1g S"S NEW HOUSE SEWER
_ _ .J. CONNECT ADDITIONALOWNiR
OWNERS AGENT /Y/ ��� BUILDING OR WORK
ADDRESS �'-`- AND/ORSEPTIC TDRAINFIELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑' DRYWELL(jAND 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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AAI THE LEGAL OWNER-OF-THE' ABOVE _ABANDON HOUSE SEVIER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP. PITS) ❑ CESSPOOLS❑
SIGNATURE � t'
-
OF PERMITTEE ^ -
WILLIAM J. FOX. COUNTY ENGINEER - VALIDATION -
7 1 5 6S AUG 2 5 4 d,4-i*D-
BY ` TB1: 5 5tf; nuc25 5 1--0Jx e wBy
DEPUTT
`m DEPUTY VYY `v _..y / "DEPUT'] -