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Home My Public Portal About5211 DOREEN AVE_Sewer__ CEOOO 362 ,BAB,ED APPLICATION FOR PERM T COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER- BUILDING AND SAFETY DIVISION r..LDING 1 JOHN A. LAMBIE. County EnginoIn ADDaes WILLIAM A. JENSEN. Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS ST. If LEGAL '�70OWNER DESCRIPTION LOT NO. O K 2 MAIL BLOCK ` TRACT / --2- ?n_ ADORES$ 9(d��j /✓JG�J�i Aq��/ !!! NO. OF SLOGS LOGS. /G�J G/l7CLf1CLrEL. NO. SIZE OF LOT Jia NOW ON LOT I CITY USE OF S ep tO '//�/7� .._ - BUILDINGS DISTRICT NO, GROUP MAP PROLE$ BY BK PG CONTRACTOfl�-rl-Gpr/ia/1'i �. C//.�0..��NNECTION DATA ' CITYTATION//'uJ •/fl� �� T.L.TEL. NO.9y�/'� ��•f.�• �1 D, DEPTH STATE y� VPPER REGISTRATION NO. / ((��Q •Y� COUNTY MANHOLE REFERENCE NO. DESCRIPTION OF WORK FEE TYPE TION OFC LEN HFRO / HOUSE SEWER CONNECTING TO OO Y. CURD P.L. M.L.TO P.L J , O PUBLIC SEWER @ $5.00 __' P:C.NO. I ' 5EPT ICTAN K.SEE Pq GE PIT OR CO.IMP, NO. JOD NO, v PITS SND/OR GRAINFIELD 310.00 �) HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT I X O PRIVATE DISPOSAL SYSTEM $3.00 C/ 6 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT MV 5[M[xi RE CORD.INSTR,NO. DATE WORK TO HOUSE SEWER ® 35.00 K' Lv LA OVERFLOW SEEPAGE PIT.GN,NFIELD EXTN.,CESEPOOL,DRYWELL,MANH O LE@ 35.00 N SLYER,REPAIR OR ALSYSTE HOUSE HWYSTAT OR ENCROACHMENT Z SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT PER MIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s zI Oo AUTHORIZATION TOTAL FEE d Q CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT TX B(y(� DESCRIBED E%IETING DWELLING TO THE PUBLIC SEWER. \ APPROVALS DATE` INSPECTOB'B SIG N ATUflE SIGNED THIS DAY OF 19_ •�/.r_(-v' OWNER OR — j_ 1. NEW HOUSE SEWER ` , e/y..`<•�L�JZ:' � OWNERS AGENT CiC!/ CONNECT ADDITIONAL DRESS BUILDING OR WORK SEPTIC TANKSPIT 151 XEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SND/OR GRAINFIELD AND STATE THAT THE ABOVE ICORRECT qAGREE COMPLY WITH ALL COUNTY ORDINANCES AND STATEE LAWS REGULATING PLUMBING AND SEWERS, CESSPOOL ❑ DRYW ELL ❑ HEREBY CEPTIFY THAT I AM PROPERLY REGISTERED ANG/OR 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, TME ABO DESCPIL DENT L)�PROPERTY- ABANDON HOUSE SEWER SIOF PER tTTFv / BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ ' SEEP.PIT(S) ❑ CESSPOOLS OVALIDATION ROBERT A. WOOD CASH SUPERVISING MECHANICAL ENGINEER _!1160 4 4 ? ,Gi v i3il b 1. 0 D � G2 � CEBDB 3-B1 APPLICATION FOR PERMIT TspeazD COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION aDILOIrvG �2// /JO - �� /�� JOHN A. LAMBIE, County Engineer ADDRESS I" WILLIAM A. JENSEN, Sup'l of Building l LOCALITY NEAREST FOR APPLICANT TO L IN CROSS ST. AL DESCRIPTION LOT NO. Z OWNERI QI\ 1/./J/J/T/J D MAIN BLOCK NO J ADDRESS /� /J SIZE OF LOT XJ i NOW ON LOT CITY OS/_=M,E_RD TEL, NO, 19 6 ;—?2 USE OF DISTRICTNO. GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR ADDRESS LLLIII—�� CONNECTION DATA ' STATION DEPTH 1 CITY TEL. NO, STATE MANHOLE RERENCE UPPER REGISTRATION NO. COUNTY R -- NO.• DESCRIPTION EC WORK FEE TYPE OF CONN FROM HOUSE SEWERCONNECTINGW R Y. CURB M.L.TO P.L, O PUBLIC SEWER @ 55.00 PC SEPTIC TA N K.SEEPAGE PIT OR CO IMP NO JOB NO. V PITS AND/OR ORAINFIELO ® STOOD K HOVATE DISPOSAL NESTING TO TRUNK TND, ROAD PERMIT NO. O PRIVCONNECT ADDITIONAL 53.00 CONNECT HOUSE SEW BLDG.OR AFFIDAVIT wMVf• [A[EY[X RECORD.INSTR.NO, GATE WORK TO HOUSE SEWER ® 53.00 . OVERFLOW SEEPAGE PIT.ORAINFIELO y EKTN.,CESSPOOL.ORYW ELL,MANHOLE® 85.00 �[[tIV—►ABANDON HOUSE HWY.OR ST.WIDENING G --yyl-- SROEAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s z o0 AUTHORIZATION TOTAL FEE I r2 CONNECTION CHARGE FEE ITHAVE AT THIS DATE A CONTRACT WIH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BV ILOING OR WORK DRESS SEPTIC TANK,SEER.FIEL PITISI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION gryO/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE E COMPLY WITH IALLNG COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYW ELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRE0 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 4BJOV E� ES' IBED R SIOEN%%TI1AL P OP TY. ABANDON HOUSE SEWER SIGNATURE / L/� 1 /�_/2 �• OF PERMITTEE BACKFILL SEPTIC TANKS ❑ // SEEP,PITISI ❑ CESSPOOLS ❑ V VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.0. CASH V& 79290' DEC 610 D 5.00~