HomeMy Public PortalAbout5137 DOREEN AVE_Sewer__ 10EBOB 6A642D I0.B2 APPLICATION FOR PERMIT [1flII
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COUNTY OF LOU ANGELES SEWER—SEWAGE DISPOSAL III
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION fA
LDING
JOHN A. LAMBIE, County Engineer alss 7 J .7WJOHN A. )ENSEN, Supt ofBuildingRESSILITY
RFOR APPLICANT TO FILL INSe sT L + VVV
LEGAL I -- yynn
DESCRIPTION LOT NO. • OWNER AyL .,
/ q t! MAIL / /V / LIA1 oL,
BLOCK TRACT ADORES$ /Ny
SIZE OF LOT /_ NOWOON LOTS CIT TEL..NOA a O
USE OF DISTRT NO. GROUP MAP PROCESSED BY
BUILDINGS
PO
IC
K
CONTRACTOR JT-/ C�t�.j.l,ji-
CT Zz
ADDRESS j S,S' :� CONNECTION DATA
CITY TEL. NO. 73791- STATION EPTH
STATE UPPER
REGISTRATION NO.
C-36 3 3 9/U COUNTY MANHOLE REFERENCE O R
NO. DESCRIPTION OF WORK FEE Ty F,COryNECTION LENGTH FROM Y
D
HOUSE SEWER CONNECTING TO Y C B P.L. M.L.TO P.L. O
PUBLIC SEWER SSA° T 1 [; p,C.NO. V
SEPTIC TANK.SEEPAGE PIT OR X JOB NO.
PITS AND/OR DRAINFIELD - 510.00 CO.IMP.NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O
PRIVATE DISPOSAL SYSTEM S.O. H
CONNECT ADDITIONAL BLDG.Ofl `V� GD AFFIDAVIT 11V[II IAS RECORD. INSTR.NO. DATE 1(LJ
WORK TO HOUSE SEWER @ $3.00 J a
OVERFLOW SEEPAGE PIT.DRAINFIELD H
EXT N.,C ESSPOOL.DRYWELL,MANHOLE @ SS.00 Z
ALTER.REPAIR OR ABANDON HOUSE MWY.OR$T.WIDENING
SEWER OR DISPOSAL SYSTEM ® 53.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT- s z o0 CHARGES
AUTHORIZATION TOTAL FEEsi V,h CONNECT N 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'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
-
OORE55 BUILDING OR WORK J J I
SEPTIC TANK,SEEP,PIT(5)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD -
CORRECT AND AGREE COMPLY
WITH
STATE THAT THE ABOVE I
WITH ALL COUNTY ORDINANCES
S AND STATE LAWS REGULATING
PLV MBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/°R ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED 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 ABOVE QEBCRI BED R JD NTIwL PR= ERTY. ABANDON H OUSE SEWER
SIGNATURE /
OF TURFPERMTEE I I ( BACKFILL SEPTIC TANKS ❑
_ SEEP,PIT I51 ❑ CESSPOOLS ❑
VALIDATION ROBERT WooO
SUPERVISING MECHANICAL ENGINEER
CK. M..0. CASH
IN
!..ILIO 2 9 3 7 t2 NOV 2 7 1 0 A 5.0 0-
�9'B'ILE�
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE 't DISPOSAL _
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING �j3 7 ` Q ��N
ADDRESS !J 'll
FOR APPLICANT T,O� FILL IN LOCALITYBUILDING 11 EAREST2l i C/
ADDRESS -S'� -37 _ //>/7�t7(�'/S��/ CROSS ST. /�/) ,/-_
LOCALITY 5Efl1Al N0. PERMIT
�NO.
A
NEAREST
CROSS ST. �FIC
//� r /` C�R}ECEEIIjV�ED BY Ready for Inspection DATE ISSUED�//.
OWNER u Pn� _170e047 t9 1G1bIS01L �/' !. //'/^/LOT / r�.3 ST
MAIL �_ USE20NE OCCUPANCY MAP
ADDRESS
�///('AfF�(e1L/ AJ ,/� 5 L'
DR. PG
CITY ✓ • V �NO. _ _ __- /T" 1 //�
Ant
��r7
CONTRACTOR :Z SA A C •/�',�./�Ant AA•JM E CO.IMP.NO. J��Z/ a A-
ADDRESS `�1,0 �A�f/L�121/Ll '�.Cf JOB NO.
CITY G/ M lAj �_ TELAO.__7, ', ,(Y TRUNK PERMIT NO.
REGISTRATION N0. '5"Z4`9'3 ROAD PERMIT NO.LEGL
DESCRIPTION LOT NO. p r7//// oy '2 (/h'") J Q. 9 1 STATE ENCROACHMENT
PERMIT NO. —�
BLOCK G TRACT / �2 U INDUSTRIAL
'n WASTE APPROVAL
S12E OF LOT gLOGV x"' 9 SNOW ON LOTS oZ CHARGES
USE OFefYJ D �S /�� ^/I-
n CONNECTION C GE FEE `
BUILDINGS Q� E-�](�
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEW ER 0 $ 3.50 J ✓ RECEIPT N0. / DA I BY
HOUSE SEWER CONNECTING TO r
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.ORAL EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 Q / /
ALTER OR REPAIR EXISTING { NO. DATE By
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ,,^^
PITS AND/OR GRAINFIELD 2.00 STATION R o4- 07
4- 0 7 DEPTH
CESSPOOL—DRYWELL f-
SPECIALCONDITIONSONLY 2.00 Al O T-MANNOLEaR EFERENCE LOWER
♦7 JTYPE O FFCONNECTIO LENGTH FROM w r/
Y. CURB / P.L. M.L.TO P.L.
OWNERS PERMIT S I 00
AUTHORIZATION TOTAL FEE ra
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_._:2. .._S..DAY OF__S d'L-��^-.L'� I � NEW NO USE SEWER i�p �a, ' /:Ily
�OWNER OR �/ /''/ CONNECT ADDITIONAL
OWNERS AGENT...rLG.. � j� '!_S..'L'.:� eSUILDING OR WORK
v r
` —0 tSEPTICTANK,SEEP.PIT(S)
ADDRESS...._...../._.............._....
_..._.__. ...._.._......._._..._....._... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT/I HAVE READ THIS APPLI• CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
Atl0/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESEWER
AND STATE OF CALIFORNIA OR THAT I AM,THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS
/�s SEEP.PIT(S))0 CESSPOOLS E]
SIGNATURE p /�s (_ .�nir!.?._.._... S�
OF PERMITTEE...__" �A ....._.._._.. _._
76A642A 663 7/53 /