HomeMy Public PortalAbout9823 ESTRELLA AVE_Sewer__ a
C980a. APPLICATION FOR PERMIT
aaoa-e.ae COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _ .....
BUILDING AND SAFETY DMSION BUILDING Z
ADDRESS
JOHN SAr A. JAMIE, County of
CASSAIT D. GRIFFIN, Bup't of Buildivg LOCALITY
,.. - ...., , r,,.. NEAREST
FOR APPLICANT TO FILL IN CROSS ST. 1 A N lrc�n nl
LEGAL
DESCRIPTION LOT N0. 0/-- OWNER
BLOCK TRAC MAIL
L ADDRESS �s (y/�C
SIZE OF LOT ON LOT r � 5. CITY TEL. N0. • i0—6 /O o
USE OF --. - . .. ._.
BUILDINGS f DISTRICT NO.H GROUP MAP FAQCESSED B,Y
a® 10
_ /4K PG
CONTRACTOR Cj�l. �. o!'�
ADDRESS L.rt pq CONNECTION DATA
CITYnl��� ��' ,JTEL. N0. �! �i�6 /S(? STATION DEPTH
STATE MANHOLE REFERENCE UPPER
' REGISTRATION NO. H COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL,DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
"ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OM=S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE C�C7 REIMBURSEMENT FEE /Y/1�f }r
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAM ON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST FEEING
TO THE PUBLIC SEWER. -
SIGNE S AY OF 19�( NEW HOUSE SEWER
OWNER OR .CONNECT ADDITIONAL
OWNERS AGENT OnI- BUILDING OR WORK •A A9I`lI{EU Y.i II``'�
SEPTIC TANK,SEEP,.PIT(S)
ADDRESS AND/ORbRA1NFIELD
1 HEREBY "KNOWLEDGE THAT 1-HAVE READ 5 CATION
AND STATE THAT THE-ABOVE IS CORRECT AND AGR TO COMPLY CESSPOOL❑ DRYW ELL❑
WITH ALL COUNTY ORDINANCES AND:STATE LAW$ 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 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESID AL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PITS ❑ CESSPOOLS [I
OF PERM ITTE r
®r H ., •VALIDATIO>--,-,, ROBERTA.WOOD
cK. M.0. /` cAaR J SUPERVISING MECHANICAL ENGINEER
fro 3 4 0 2 OCT 11 O A 3.0 O
Y1
;BABA° - APPLICATION FOR PERMIT
BeEeaDIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer I '. _. _ - . .-'", --'- . '
County of Los Angeles BUILDING -982
C) ZrP �IJ
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS J U LL_.
T) CASSATT O. GRIFFIN. SUPT OF BUILDING - LOCALITY /
FOR APPLICANT TO FILL IN CROSS ST. Y t h
LEGAL
s DESCRIPTION LOT NO, OWNER E ,
MAIL
BLOCK TRACT ADDRESS
NO. OF BLOBS. n CITY TEL. N0.
1. SIZE OF LOT NOW ON LOT Fi
USE OF lA A- DISTRICT NO. GROUP MAP
BUILDINGS
't BK PG
CONTRACTOR A J � _ K
CONNECTION DATA
t ADDRESS
CITY �J� �i'� ,STATION Al � ' / DEPTH i ,
TEL. N0. et/ V ' z
/ n I' MAN HOLE REFERENCEPPER
STATEWBR'
REGISTRATION NO. COUNTY �,tt
NO. DESCRIPTION OF WORK FEE '7 I E UPPFR MN'
HOUSE SEWER CONNECTING TO TYPE OF S,CTION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB) P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD +� P. C. NO. -
EXTN..CESSPOOL,DRYWELL,MANHOLE @ $ 2.00 CO. IMP. NO. / �./ JOB NO.
HOUSE SEWER CONNECTING TO - - //9 � Q'
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
_ WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL'
CHARGES
CONNECTION CHARGE FEE »-r..... -
OWNER'S PERMIT $ 00 REIMBURSEMEN T FEE ✓� �r
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CDN- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT.
THE ABOVE DES JIBED EXISTING DWELLING ' I �pI� '.
TO THE PUBLIC BEER 2 E3 -1\ NEW HOUSE SEWER, _/
� �� CI• '�
SIGNED THIS AY OF CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
00
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELLI]
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITHALL 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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCON HO PLUGAUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El
SIGNATURE
SEEP. PIT(S) [_1 CESSPOOLS
;� -�1 d� •Q OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLSG. INSPECTOR
rc. M.0. CASH
M
;_qC 5 2 4 8 DEG 2 Q 4 4.5 O