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HomeMy Public PortalAbout5136 DOREEN AVE_Sewer__ CEBOB 3-E9 76A692D APPLICATIONFOR PERM4T 'I COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 'ul DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / /J JOHN A. LAMBIE. County Engineer ADDREss WILLIAM A. JENS EN. Supt of Building LOCALITY NEAREST FOR APPLICANT TO FML INS CEDES 9T,/�p LEGAL .(�/I �O L DESCRIPTION LOT NO. - / OWNER � MAIL BLOCK TRACT &2Z_-/ a AOOflE55 NO, OF BLDGS. SI2E OF LOT © O NOW ON LOT CITY TEL. NO. I LOINCS B BUOF ^ . DISTRICT NO. GROUP MAP PROCESSED BY BV .(%�/ C CONTRACTOR y' O� Cl /[i ADDRESS s O . CONNECTION DATA CITY T.L. NO. STATION i q DEPTH STATE !Y UPPER MANHOLE REFEgENCE REGISTRATION NO. � GOUNTY / OWER" NO. CESCRIPTION OF WORK FEE TYPE OF CON CT IO LENGTH FROM HOUSE SEWER CONNECTING TO Y. URB P.L. M.L.TO P.L. PUBLIC SEWER 53.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO. JOB NO. PITS AND/OR DRAINFIELD � 3I0.00 0 /� O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. .1IAD PRIVATE DISPOSAL SYSTEM ® $3.00 ✓L/ CONNECT ADOITIONAL BLDG.OR AFFIDAVIT An su[Rf gECORO.INSTR.NO. DATE WORK TO HOUSE SEWER $3.00 O OVERFLOW SEEPAGE PIT.GRAINFIELD EXYN..CESSPOOL,DRYWELL.MA NHO LES SS 00 - ((yJJ ALTER.REPAIR OR A HOUSE HWY.OR ST.WIDENING a SEWER OR DISPOSAL SYSTEM a $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES R OWNES PERMIT s z o0 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE REIMBURSEMENT FEE '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLICS APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS /�DAY OF ✓ i OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL 14241= AA( BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PITIS) I HEREBY ACKNOWLEDGE THAT I HAVE READ TH15 APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(9) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD SUPERVISING MECHANICAL ENGINEER CK. M.0. LASH LAC03 2 2 3�— FEB21 1 O D 5.0 OeY <" '6A6426D APPLICATION FOR PERMIT $ @ G412-54 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING �$� 2 / �:NO. � WM. J. FOX, COUNTY ENGINEER ADDRESS ✓C�i CASSATT D. GRIFFIN, SUPT OF SUILOIrve LOCALITY Tryi/O��FOR APPLICANT TO FILL IN NEARESTcftOSS STLEGAL ��� , ,�❑ESLRIPTION LOT N0. OWNER �'BLOCK ,/ TRAC.Ty AOMA IRESSNO OF SIZE OF LOT p6 CJ�O @ NOW ONBLOTS /rCITY TE USE OF BUILDINGS �f/e-ye"?l'P� / DISTRICT N0. GROUP MAP PG CONTRACTORe? �� �� S IK fflB ADDRESS ,A:fn.d 4? N. t,L�, CONNECTION DATA CITY7T�en��p -',P ��j TEL. NO. el,!;4 STATION O J--k7, DEPTH G ❑ STATE f>, y> ly' D MANHOLE REFERENCE 1 REGISTRATION NO. f��® � ❑ COUNTY r9 OI nCr Ig998it LOVER TYPE OF CONNECTION LENGTH FROM NO. DESCRIPTION OF WORK FEE .v3 CURB %mLn M.L.TO P.L. 17.J O HOUSE SEWER CONNECTING TO r_ PUBLIC SEWER © $ 3.50 �Q HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 _ CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. �� / JOB, NO. WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING-SEWu//z g ALTEP..OR DPMI AL SYSTEM 1.00 TRUNK PERMIT N0. ROAD PERMIT N0. 7 J�J Y 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- DP,YWELL WASTE APPROVAL SPECIAL CONDITIDNS ONLY 2.00 CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 AUTHORIZATION TOTAL FEE 5o REIMBURSEMENT FEE 1 HAVE -THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATUR TO THE PUBLIC SEWER SIGNED THIS = DAY OF ��� 79�$•.$� NEW HOUSE SEWER 7 / OWNER OF / CONNECT ADDITIONAL OWNERS AGEYi_ _.4 - tOZ. BUILDING OR WORK NK,CJD/G / SEPTIC TANK SEEP, PIT(S) ADDRESS AND/OR SEEP, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ ANO'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 IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. / BACKFILL SEPTIC TANKS❑ �/T !tel AGJCnIfI�U SEEP'. PIT(S) ❑.CESSPOOLS ....__-� SIGNATURE ..w..... OF PERMITTEE WILLIAM J. FOX, COUNTY ENGINEER VALIDATION BY _.TO 5 2Y9 On JUL 1 4 4-50 � DEPUTY DEPUTY BY BY//�'�/ t ® DEPUTY // C�'�i� DEPUTY Tem:m p (,d &rp y CEB0R 3-E4 9686420 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS tl WILLIAM A. JENSEN, Supt of Building LOCq LITY �� NEAREST FOR APPLICANT TO FILL IN ORD96 6T. �� LEGFL °ESCRI PTION LOTNO OWNER MAIL BLOCK TRACTO ADDRESS _ NO, OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF ^ DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS SJ.f/ ^ BK PG CONTRACqTANK,SEEPAGE ♦ D � ADDRESS CONNECTIONDATA CITYEL, NO. 8 STATION DEPTH STATE REGISTRATION COUNTY MANHOLE REFERENCE •� LOWER NO. ORK FEE TYPE OF CONNECTION LE GTN F M HO NG TO Y. CURB PU ® $5.00 P.C.NO j� SEPTIC AGE PIT OR JOB NO. O_ PITS ANO/OR DRAIN FIELD 510.00 CO.IMP. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U PRIVATE ADO ITIONAL SYSTEM ® 13,00 CONNECTORKTOHOUSE EWER G.OR `5' I �F/� AFFIDAVIT uv 40tNtNi RECORD. INSTR.NO. DATE O WORK TO HOUBE S E PIT ® 13.00 LC L OVERFLOW SEEPAGE GRAINFIELD ~ E%TN.,CES6POOL,°RYW WELL.ELL.MANHOMOLE® $5.00 U ALTER.REPAIR OR ABANDON MOUSE HWY. OR 6T,WIDENING L SEWER OR DISPOSAL SYSTEM 33.00 STATE Ery CROACHMENT Z PERMIT NO. _ INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT s z o0 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 'IHAVE 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 °ATEIN ECTOR' SIGNATURE SIGNED THIS DAY 0/// JJJ 19_ OWNER OR / /.IAl NEW HOUSE SEWER OWNERS gGENT� CONNECT ADDITIONAL BUILDING D WORK ADDRESS SEPTIC TANK.SEEP. PITI6) HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AN./OR DRAINFIEL° AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCEE S AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL C3 °RYW ELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABO DESC I ED RESIDENTIAL P PER ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ _ SEEP.PIT ISI ❑ CESSPOOLS VALIDATION ROBERT WOOD CK. M.0. cg9H SUPERVISING MECHANICAL ENGINEER L' 4 1 5 5 u APR 8 1 a D 5.0 0