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Home My Public Portal About5223 DOREEN AVE_Sewer__ 1-1 GEBDB 3-B: APPLICATION FOR PER TsgeazD COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 0c)/2. JOHN A. LAMBIE. County Engineer ADGRESS WILLIAM A. JENSEN, Supt of Building T LOCALITY / NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL J //[[ DESCRIPTION LOT ry0. V OWNER MAIL BLOCK (� TRACT //..LVO 90.K-203 °� DRE55 }}�� NO. OF BLOCS. SIZE OF LOT `' X/�0 NOW ON LOT /CJ CITY TEL. O -47 USE OF /�`,/N` BUILDINGS L CiSLQl��G� DISTRICTN GgOVP MPP PROCES 0V P' Y Ti BK PG CONTRACTOR �' !��p T J O y ADDRESS- CONNECTION DATA CITY Y EL. NO 1 STATION ^' ��OC DEPTH TATE RL UPPER REGISTRATION NO. , COUNTY MANHOLE REFERENCE LOWER NO. DESCRIPTION O f WORK FEE TYPE OF CO NECTI N LENGTH FROM } HOUSE SEWER CONNECTING TO Y. C B p.L. .L OB O PUBLIC SEWER 85.00 SEPTIC TANK.SEEPAGE PIT OR 4.0 / PV N U PITS ANOIOR DRAINFIELO @ 510.00 CO.IMP.N JOB NO. HOU5E SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT No. O PRIVATE DISPOSAL SYSTEM 53 00 CONNECT ADDITIONAL BLDG.OR Y.M AFFIDAVIT uv u5d[xi RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER � $3.Dp ✓ V K' [[ OVERFLOW SEEPAGE PIT.ORAINF IELD E%TN..CESSPOOL,DRYW ELL,MANHOLE 55.00 y ALTER.REPAIR OR ABANDON HOUSE HWY.OR BT.WIDENING Z SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT PERMIT NO. ` I VS RIAL C AR ES OWNER PERMIT z o0 AUTHORIZA N TOTAL FEE (J� INECTI 1 CRARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE , TRACTOR TO CONN ECT THFF// gBOVE DESCRIBED E%ISTINO DWELLING TO THE PUBLIC SEWE �( '.% APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS O 19/ _ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK v SEIC T4NK.SEEP, PIT(S) I HEREBY ACKNOWLEDGE THAT I H E HEAD THIS APPLICATION APTND/OR DRAIN FIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT 1 4M 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 ANO RESIDE IN, THE ABOVE DESV IBE RE IDENTIAL PROPE Y. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ElOF PERMITTEE ❑ SEEP.PIT I51 ❑ CESSPOOLS VALIDATIODT----, ROBERT WOOD CK. M.0. CASH SUPER-VII SIgNG MECHANICAL ENGINEER 70AS42D DESOS8.69 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BmLo1NG ADDRESS IOI-RP A. LAMRIE, C.=tF Ea ear CASSATT D. GRIFFIN, Supt of Building LOCALITY C NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL OWNER n /. DESCRIPTION LOT NO. , K/frl BLOCK G TRACT MAIL J ® ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF � DISTRICT N0. GROUP MAP PR ESSED B BUILDINGS aJ�'•� IBK PG o I 1}C, J CONTRACTOR (/_IJ,{�J ADDRESS J '/: CONNECTION DATA CITY L... TEL.N0.4� (pykB STATION CZ -8 - - 0. (i DEPTH cy •� [] STATE MANHOLE REFERENCE REGISTRATION NO. S I H COUNTY LOWER NO. DESCRIPTION OF WO K FEE HOUSE SE WEERCCONNECTING TOPUBLIC @ $3.00 ¢3 L TYPE OF CONNECTION LENGTH FROM C— SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITSAND/OR DRAINFIELD @ $3.00 - �/- /{ OVERFLOW SEEPAGE PIT. DRAINFIELD T' ��Z/ EXTN..CESSPOOL. DRYWELL @ S2.00 ,�g _ PRIVATE DHOUSE IISPOSAL SYST MER CONNECTING TO @ $1.00 CO. IMP.NO. JOBB mo-0)I-3 / AW CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO: WORK TO HOUSE SEWER @ $1.00 ALTER,REPAIR PAI IRO R ABANDON HOUSE @ $1 00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS - PERMIT 2 DO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE C- REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19 NEW HOUSE SEWER OWNER OR /Ii+ CONNECT ADDITIONAL OWNERS AGENT / '� F BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP. PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR TH T 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN 1 PROPERTY. BACKFiLL LL(S)P IC TANKS CESSPOOLS ❑ SIGNATURE OF PERMITTE ®. VALIDATION) ROBERT A. WOOD CK. M.0. GASH/ SUPERVISING MECHANICAL ENGINEER U&)8 0 2 5 21 Pi'lR 2 2. 1, 0 A 5.0 0 VI c D CE608 APPLICATION FOR PERMIT eeoe e.ae COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING /V Y JOHN A. LAMIE, Countp Engineer ADDRESS CASSATT D. GRIFFIN, Supt of Building LOCALITY G j' NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT N0, OWNER TRACT 2t MAIL BLOCK C, T f� ADDRESS NO,OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP P ESSED A BK PG CONTRACTOR ADDRESS 5r CONNECTION DATA CITY TEL.NO j,d (j/le,,_ E STATION -TQ DEPTH �j STATE MA L RE NC PPER REGISTRATION NO. .7 I� ® COUNTY LOWER N0. DESCRIPTION 0 WORK FEE PUBS CR SEWER CONNECTING TO @ $3.00 t YPE OF CONNECTION LENGTH FROM SEPTIC PITT AND/OR TANKDSEEPAGE RAINFIE PIT OR @ EB.00 Y. CURB P,L. M.L.TO P.L. OVERFLOW SEEPAGE PIT.DRAINFIELDC / EKTN..CESSPOOL.DRYWELL @ $2.00 P.C.N0. /i HOUSE SEWER CONNECTING TO CO.IMP. NO. JOB N0, PRIVATE DISPOSAL SYSTEM @ SI.00 CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER @ 51.00 SEW EFOR OITP OR AL SYSTEM HOUSE @ TI 00 S�T.R�"�..c�vncn�^'^mNTZ�K / O INDUSTRIAL WASTE APPROVAL CHARGES OWNERS -PERMITS CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE i d J rJ REIMBURSEMENT FEE I HAVE CON- TRACTORA TO CONNECT THE ABOVE DESCRIBED EXIISTINGS DATE A CONTRAWITH THE HEREINAMEDWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERSAGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP. PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL [IWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAip,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEyTIjL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT($) ❑ CESSPOOLS ❑ OF PERMITTE ®• VAIMATIOItJ� ROBERT A. WOOD CK, M.o. usN SUPERVISING MECHANICAL ENGINEER LJjCD7704MAR 1585 A 2 0.0 0 M