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Home My Public Portal About5111 DOREEN AVE_Sewer__ r 76AC4 ,°-°: APPLICATION FOR PERMIT CE808 D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING IOHN A. LAMBIE, County Engineer AD RES. WILLIAM A. JENSEN, S.p't Of Building LOCALITY f (/ NEAREST FRR AP Il TO IN `ROSS ST. LEGAL /�I -/ L' BE SC RIPTION LO�'NO _ ri� OWNER s-✓- MAIL �� /y// BLOCK TRACT A°DRE55 NO. OF BLOCS. J� SIZE OF LOT NIDW ON LOT � CITY / L. NO. USE OF BUILDINGS ,(/LOGf� DISTRICT NO. G OUP MAP PROCESSED BY �/ BK PG 1 CONTRACTOR O� �yC� ADDRESS /J b,J ✓G�QO�J r CONNECTION DATA CITY ��1i/(L�/� TEL. NO. TATION ♦ ♦ /Y/�DEPT!) 9O STATE MANHOLE REFERENCE \ Y 1 •1 } REGISTRATION NO. f ✓ COUNTY LOWER a NO. DESCRIPTION OF WORK FEE TYPE DF CON E LENGTH FROM O HOUSE SEWER CONNECTING TO O^ Y. q - P L M.L.TO P.L. V PUBLIC SEWER ® $5.00 " PC NO. p[ SEPTIC TANK.SEEPAGE PIT OR ' JOB NO. O PITS AND/OR DRAtNFIEL° ® 510.00G. r HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT G PRIVATE DISPOSAL SYSTEM 53.00 W CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIV[. I45CIdIIIIT RECORD.INSTR.N DATE a WORK TO HOUSE SEWER @ 5,LOO OVERFLOW SEEPAGE PIT.GRAINFIELD EXTN_CESSPOOL.DRYWELL,MANHOLE N $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM U $3.00 STATE E .ENT PERMIT I ILI {` - INDUSTRIA VT WASTE APPR ✓ OWNERS PERMIT 8 z 00 CHARS AUTHORIZATION TOTAL FEE OO CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR-5 SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR - - NEW HOUSE SEWER :'♦J.,I(/jq / �� OWNERSAGENT I (� CONNECT ADDITIONAL _BUILDING OR WORK ADDRESS SEPTIC TANK,S PIT(S) HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE ICORRECT AND AGREE COMING WITH ALL COUNTY ORDINANCES S qNO STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYW ELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED PND/OR ALTER.REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM cCALIFORNIA OR TH M THE LEGA O AND INTEND TO DISCONNECT PLUG AND flES1DE IN. THE A E ESCRIB DENT PROPERTY. ABANDON HOUSE SEWER SIGNATUREA .✓� BACKFILL SEPTIC TANKS ElOF PERMITTE ❑ _ SEEP.PIT 151 ❑ CESSPOOLS ALIDATION ROBERT A. WOOD cK. M.0. CASH SUPERVISING MECHANICAL ENGINEER 1 5 1 1 6 OCT O - M 16 1 � 7.0 0 4 CEBOe 10-62 APPLICATION FOR PERMIT T6AB42D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY.DIVISION 3u1LOING I JOHN A, LAMBIE, County Engineer ADDRESS f4S✓ WILLIAM A. JENSEN, Supt o1 Building LOCALITY NEAREST R APP I T TO FILL 114 RD85 BT. LEGAL DESCRIPTION � ' OWNER �. ADIL DRESS BLOCK TRACT NO. OF SLOGS. a� SIZE OF LOT NOW ON LOT CITY j TEL. .NO. USE OF DISTRICT NO. GROUP MAP P CEBSEO BY BUILDINGS �-K /• L - BH PG coNTRaccoR '01 Q c76Y/JC}/74 /�• I ADDRESS p ///G &?d ��.C///ONNECTION DATA CITY TEL. NO � ATION DEPTH S �` TATE REGISTRATION NO, Fj`Xlfk�f' ❑ STATECOU MANHOLE REFERENCE / �jfTl LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNEC LENGTH FROM r HOU SEWER CONNECTING TO / Y. C P.L. M.L TO P.L. LIC SEWER ® 83.00 / P C NO O SEPTIC TANK,SEEPAGE PIT OR JOB NO. PITS ANO/OR DRAINFIELO @ sm.oO CO.I.P. NO. } HO U SE SEWER CONNECTING TO TRUNK PERMIT NO. • ROAD PERMITN PRIVATE DISPOSAL SYSTEM ® S.O. O CONN ECT ADDITIONAL BLDG,OR AFFIDAVIT uv e.•S[Y[xi RE CORD. INSTR.NO. DATE W WORK TO HOUSE SEWER @ $3.0° d OVERFLOW SEEPAGE PIT.GRAINFIELD M EXTN.:<ESBPOOL.DRYWELL,MA LES f5.00 z ALTER,REPAIR OR ARANO° O USE HWY.OR ST.WIDENING SEWE .OISPOSA YS ® S3.00 STATE ENCROATPMENT PERMIT NO. INDUSTR W ASTEAP L C AFGES OWNERSPERMIT s z 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA fEO CO.- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIG NATURE SIGNED THIS DAY OF 19_ OWNER OR ` NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS �1 PT1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AN./OR TANK,SEEP,PIT FIT(S) AND/OR DRAINFIEL° AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY REGULATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING D PLUMBING pN D.SEW ERS. - � CESSPOOL ElRYW ELL ❑ ' 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER. REPAIR,SEWER OR LICEN5ED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT M THE LEGAL-OYCNER OF. AND INTEN° TO DISCONNECT PLUG AND - RE51DE N. THE AS E ESCRI SID TIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS El PERM ITTE J SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER L& 1512G OCT16 11 0 25,00— d