HomeMy Public PortalAbout8842 - 8842 1/2 ELM AVE_Sewer__ fA'Ac, ' 51-0".) A`/ /—'X, &I` C-1f,. ®f= A&7 /J/�x, v-i. C�dbri• lI*c Ij i C-1 ;
F, Ss)w7 7"m g,¢ a crl► 0,o ' VP A P7 7��, IV,, o 7'°,QF'd::�
�fyp7 ®,& 7+®,,
76&6420 0-63 APPLICATION FOR PERMIT
���•�^./�� ^tt/� IJ
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILE)ING
JOHN A. LAMBIE, County Engineer ADDRESS S — ✓ — ^�
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST FAj
rBLOCK
O APPLICANT TO FILL IN
CROSS 5T.
77
LOT NO. OWNER MAIL / ITRACT36 ADDRESS {/ibNO. OF BLDGS. (0 X NOW ON LOT CITY TEL. .NO. G RES/� _ �) DISTRICT NO. GROUP 1 M/AP PROCESSED BY
SK
V0E ' �C7�bJ C5 / �PG
ADDRESSCONNECt5a. ;ei244i OR .
TION DATA
CITY 64 Gay)149 TEL. NO. C STATION DEPTH
/i STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. / ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIONGTH FROM
HOUSE SEWER CONNECTING TO - Y. CURB P.L. M.L. P.L. }
PUBLIC SEWER @ $5.00 d
SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO. JOB NO.PCNO
NO. O
PITS AND/OR DRAINFIELD @ $10,00 V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d'
PRIVATE DISPOSAL SYSTEM @ $3.00 ^
CONNECT ADDITIONAL BLDG.OR AFFI AVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE H
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD pV W
EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $5.00 C
ALTER,RE{41R OR ABANDON HOUSE WY. OR ST.WIDENING 2
SEWE O D SPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO,
INDUSTRIAL
WASTE.APPROVAL
CHARGES
OWNERS PERMIT s 2 00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL 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. �i ^T APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 1 /�./ . 19 L5
OWNER 0A � e NEW HOUSE SEWER
OWNERS AGENT .f��!'
P)A
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK r� (//tltlP
SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD 1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY l�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY 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 I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE %
OF PERMITTEE BACKFILL SEPTIC TANKS ❑
_
SEEP.PIT(S) ElCESSPOOLS C]
VALIDATION ROBERT A. wooer
SUPERVISINGGMECHANICAL ENGINEER
C M.O. CASH
6 9 4 312 NOV 1 1 0 A 8.0 Of-,
Ab42
76A642D 0-63.: APPLICATION FOR PERMIT
u
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS J /
WILLIAM A. JENSEN, Sup't of Building C�
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL G' +/•�
DESCRIPTION LOT NO. J ` OWNkR 6 ' / Z
MAIL
BLOCK TRACT ADDRESS .TGR
NO. OF BLS'OG
�'
SIZE OF LOT �NOW ON LO/OTT� CITY 1()( TEL. -NO. /
BUILDINGS I,(J ,Iy{./ '� ' Gty. �(r.� DISTRICT NO. GROUP MAP •PR ESSED BY
BK PG
CONTRACTOR
(! I C GO
ADDRESS . f CON C 'TON DATA I
CITY TEL. NO. �— o O STATION DEPTH _
ElSTATE MANHOLE REFERENCE q ^+ UPPER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ S5.00 d
P.C.NO.
SEPTIC TANK,SEEPAGE PIT OR
IMPNO
PITS AND/OR DRAINFIELD @ 510.00 CO. . . .108 NO. O
V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ S3.00 9x
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 7 wA1 Ep EASEMENT RECORD. INSTR.NO. DATE
WORK TO HOUSE SEWER @ $3.00 0
OVERFLOW SEEPAGE PIT.DRAINFIELD W
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ S5.00 •Zp,
WY. OR ST.WIDE /NG
R ABANDON HOUSE
SEWER .Y M @ $3.00 STATE ENCROACHMENT z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ _ 2 00
AUTHORIZATION TOTAL FEE . - U CONNECTION CHARGE FEE CHARGES
-
'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLISEWER. _ APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL 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 OWNEROF, AND INTEND TO DISCONNECT PLUG AND p� 4
RESIDE IN, THE AB VE DESCRIBED RESIDENTIAL ./P'RROOPEE RoTY. ABANDON HOUSE SEWER
SIOGF APER MITT EE �_ , QC( .0�%1�/�L BACKFILL SEPTIC TANKS ❑ 1
SEEP,PITS) ❑ CESSPOOLS.❑
VALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENGINEER
CK.
FEB5 1 C A 5
u 08 9 3 5.110)0- r
yZZ�ir/