HomeMy Public PortalAbout9071 EMPEROR AVE_Sewer__ D
ciaos APPLICATION FOR PERMIT '
sos a-se COUNTY OF LOS ANGELES
-SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER f
BUILDING AND SAFETY DIWSION BUILDING
JOHN A. LAMBIE, County Engmeer
CASSAIT D. GRIFFIN, Supt of Busldmg LOCALITY /7
NEAREST
FOR APPLICANT TO FILL IN ' CROSS ST
LEGAL
OWNER /
DESCRIPTION LOT NO
BLOCK TRACT MAIL
ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF D[STRICT NO GROUP MAP OCESSED BY
BUILDINGS ✓ BK PG -
CONTRACTOR 5
ADDRESS f. - CONNECTION DATA
CITY NO STATION `� DEPTH
�O .I STATE MANHOLE REFERENCE ./ UPPER
REGISTRATION NO �D'` COUNTY G
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
ITS AND/OR DRAINFIELD @ $3 00 Y CURB P Ljv M L TO P L
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO F JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER Q $1 00
SEWER OR ORABANDON SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNWS PERM 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE a REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THISC'-// A OF ` I NEW HOUSE SEWER i l 0 0
OWNER OR CONNECT ADDITIONAL'
OWNERS AGE N BUILDING OR WORK
ADDRESS SEPTICTANK SEEP PIT(S)
AND/OR DRAINFIELD %
I HER Y ACKNOWLEDGE THAT 1 AVE 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 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 M THE LEGA OWNER OF THE ABOVE
L
ESCRIBED RESIDENT P OPERTY. BACKFILL SEPTIC TANKS _ -
GNATURE SEEP PITS CESSPOOLS
OF PF
®r VALIDATIOJP ROBERT A WOOD y
�, m,p, CJ18fi
SUPERVISING MfiCHAN1CA1,ENGINEER
L109 7 6 5-U-) JUL A , 5 .0 0 �,
DEPAIVirMENT OF COUNTY ENGINEER i SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
BUILDING %, 24
t
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST
LOCALITY � a,A�� I DISTRICT NO SERIAL NO PERMIT NO
NEAREST // ^J( A u�f/,�LC�(/, S
CROSS ST 4/ e,
l (meq RECEIVED BY Ready for Inspection D TE/ISSUED
OWNER P�" iL A ► —C ��
MAIL f
ADDRESS �— USE ZONE I OCCUPANCY { BK MAP PG
CITY TEL NO
CONTRACTOR CO.IMP NO
ADDRESS �y � (�11 SOB NO
CITY t TEL NO �4 � 4 � lit) TRUNK PERMIT NO
REGISTRATION NO ,1g U IS` ❑ COUNTYa
���FFF ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO S PERMIT NO
STATE ENCROACHMENT
BLOCK TRACT�M/�y � " INDUSTRIAL
NO 8 BLDGS WASTE APPROVAL
SIZE GF LOT r NOW N LOT CHARGES
lr6USE OF
BUILDINGS �q CONNECTION CHARGE FEE
G/�„�f� �
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOREIMBURSEMENT FEE
PUBLIC SEWER @ $ 350 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRiVATE DISPOSAL SYSTEM 100 �L►`
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO DATE I 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 DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT 1 00
' Y CURB PL M L TO P L
AUTHORIZATION TOTAL FEETOTAL FEE (E ,
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS ___ DAY OF' 19_ _ NEW HOUSE SEWER �,�!L✓
OWNER OR (//` f` CONNECT ADDITIONAL
OWNERS AGENT �,Q�-A { _ ��JA. _ _ BUILDING OR WOREPTICTANK SEEPK
ADDRESS _ \- - — - AND/OR DRAINFIELD PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL\I DRYWELL 0, -/�
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE _ C G
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSI ALTER,REPA R,SEWER OR v
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED' DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY' ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-'
ER OF THE ABOVE SCRIBE RESIDE 1 PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE .!C// SEEP PIT(S)0 CESSPOOLS E
OF PERMITTEE _ _ _ I
76A642D 663 1/53 I