The URL can be used to link to this page

Home My Public Portal About5220 DOREEN AVE_Sewer__ CEBOB B:az a' APPLICATION FOR PERMIT /y1(11,1 76AO420 11 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL u DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BD]LD1NG 9 JOHN A, LAMBIE. Counly Engineer ADDREss /� WILLIAM A. JENSEN. Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CHOSE GT. LEGAL /1�� OESCR I PTI ON LOT NO. T / OWNER MAIL BLOCK TRACT / �v ADDRESS NO. OF FILE... SIZE OF LOT NOW ON LOT , CITY TEL. NO. USE OF /I /f DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS a�C� �� 0/'�, BK PG CONTRACTOR (\l ADDRESS / S E // 77: CO�+NNNN11ECCTION DATA I � I/ I. � ATION DEPTH CITY N TEL. NO. T H ❑ STATE UPPER REGISTRATION NO. ❑ COUNTY MANHOLE REFERENCE _ L NO. DESCRIPTION—� EC ;1_WORK FEE TYP CON! C LENGTH FROM HOUSE SEWER CONNECTING TO Y. QP.L. M.L.TO P.L O PUBLIC SEWER 55,00 1 r PITS A TANK.SEEPAGE PIT OR / JF.C.NO V PITS AND/OR ORgINFIELD � 810.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. (� PRIVATE DISPOSAL SYSTEM 53.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 1 W.11V" IXIIIWX RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER 53.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EKTN..CESSPOOL.DRYWELL.MANHOLEf5.00 �y ALTER.REPAIR OR ABANDON HOUSEHWY.OR ST.WIDENING L BE WER OR BIER OSA L SYSTEM 53.00 STATE EN CRO ACHMENT PERMIT NO. INDUSTRIAL W TE APPR V L C E$ OWNERS PERMIT s z o0 AUTHORIZATION TOTAL FEE jr l� CONNECTION CHARGE FE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTORS SIGNq URE SIGNED THIS DAV OF 19 OOWNERS AWNER OR � NEW HOUSE SEWER GE NT�JA� CONNECT ADDITIONAL BUILDING OR WORN ADDRESS SEPTIC TANK.SEEP,FIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DNYWELL ❑ IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 Al, THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE N. THE ABOV SV RI C. RESIDENTIAL PRFZ.TY. P ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ EP,'IT'S ❑ CESSPOOLS VALIDATIOP ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. LA$ LA'C05601"� OCT161 0 D 7.00— CEROBAPPLICATION FOR PERMIT JBA892a� COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIADDRESs JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of Building c LOCgLITY NEAREST G FOR APPLICANT TO FELL IN CROSS ET. LEGAL DESCRIPTION LOT NO. WHEN MAIL BLOCK TRACT y ADDRESS NO. OF NIL SI2E OF LOT NOW ON LOGS CITY TEL. NO. USE OF // i DISTR ICT NO. GROUP MAP PROCESSED BY BUILDINGS J� �� BK PG CONTRACTOR ADDRESS t CONNECCTTIION ATA CITY A A TEL. NO.�/L O y ® ST ION � { .�{. DEPTH J /' /j/ R STATE MANHOLEpREFE^EYRENCE lL(/ / UPPER REGISTRATION NO. �J G COUNTY J NO. DESCRIPTION OF ORK FEE I TYPE OF CON CT LENGTH FROM } HOUSE SEWER CONNECTING TO Y. �� P.L. M.L.TO P.L3 S O PUBLIC SEWER $5.00 ' Lr _ P.C.NO. SEPTIC TANK.SEEPAGE PIT OR B CO.IMP.NO. JONO. V FITS AND/OR GRAINFIELD @ 510.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM ® $3.00 �O CONN ECT ADDITIONAL BLDG,ORAFFIDAVIT AIV514INI RECORD,INSTR,NO. DATE O WORK TO HOUSE SEWER 53.00 Sj OVERFLOW SEEPAGE PIT.GRAINFIELD EXTN.,CESSPOOL.DRYWELL.VA OLEO $5.00 yy ALTER.REPAIR OR ABA NOON USE HWY.OR ST.WIDENING L SEWER OR D ISPOSAL STE / 53.00 STATE ENC ROACHMENT f PERMIT N0. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT E - EB AUTHORIZATION TOTAL FEE CONNECTION CHARG FEE I 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 INSPECTOR5 SIGNATURE SIGNED THIS—DAY OF�19— OWNER OR NEW HOUSE SEWER OWNERS AG ENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PITI51 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/DR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING El AND SEWERS. CESSPOOL ❑ DRYWELL IHEREBY 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 D SCRIBED RESIDENTIAL P PERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ SEEP.PIT 151 ❑ CESSPOOLS VALIDATION ROBERT A. WOOD CK. M.o. cwsH SUPERVISING MECHANICAL ENGINEER LALO5 6 0 2EJo OCT16 1 1 D 2 5.00~ Q