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Home My Public Portal About10764 FAIRVIEW AVE_Sewer__ �qF3 W C 61 6AA642 APPLICATION FOR PERMIT 6420 D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION =CRO JOHN A, LAMBIE County Engineer W44 ILLIAM A JENSEN Sup t of Building_ NEAREST FOR APPLICANT TO FILL IN SS ST LEGAL DESCRIPTION LOT NO OWNER BLOCK TRACT MAIL ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GRO MAP PROCESSED BY d,�•V P6 CONTRACTOR �! Q/ ADDRESS o CONNECTIO DATA CITY I(Ek4NO 5N 0 DEPTH STATE REGISTRATION NO B COUNTY MANHOLE REFERENCE UPPER NO DESCRIPTION OF _WORKr FES,'/- HOUSE E HOUSE SEWER CONNECTING TO �` Q PUBLIC SEWER C.�0 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CUR P L M L TO P L PITS AND/OR DRAINFIELD @ 59 00 OVERFLOW SEEPAGE PIT DRAINFIELD >- EXTN CESSPOOL DRYWELL @ E2 00' Cl- HOUSE HOUSE SEWER CONNECTING TOP C NO O PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO V CONNECT ADDITIONAL BLDG OR ORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO d' W SEWER OR DISPOSAL ABANDON HOUSE @ $1 00 STATE ENCROACHMENT O PERMIT NO V W INDUSTRIAL 0_ WASTE APPROVAL N CHARGES ? OWNERS PERMIT g 2 OO CONNECTION CHARGE FEE i=ORIZATION I TOTAL FEE REIMBURSEMENT FEE HAVE AT DATE A CONTRACT WITH THE HENAMED CN. ACTOR TO CIONNECT THE ABOVE DESCRIBED EXRSIN G DWELLING APPROVALS DATE INSPECTOR S SIGNATURE 0 THE PUBLIC SEWER IGNED THI DAY OF 19 NEW HOUSE SEWER �d Se? %.vR [ NER OR CONNECT ADDITIONAL ` df NERS AGENT BUILDING OR WORK ESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL LL COUNTY ORDINANCES AND STATE LAWS REGULATING VG AND SEWERS ALTER REPAIR SEWER OR STEM BY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL AND AS REQUIRED BY LOS ANGELES COUNTY AND ST TE OF DISCONNECT PLUG AAND A OR THAT I AM THE LEGAL OF TH ABOVE ABANDON HOUSE SEWER RESIDENTIA ERT BACKFILL SEPTIC TANKS ❑ VEP PIT(S)4Q CESSPOOLS TTE r V j;I, 0{�O ROBERT A WOOD cK. o usx SUPERVISING MECHANICAL ENGINEER 1 4 5 3% . L 2 1 0 ® 7.00- � �r J-1 -61 76A6423-61 APPLICATION FOR PER IT 76A 642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSrL DEPARTMENT OF COUNTY ENGINin or EER BUILDING AND SAFETY DIggVISION ABUILDING DDRESS 10764 E. FAIRVIEW WILLIAM; ENSENCSupI ofnBuildmq LocnuTY TEMPLECITY C(1LIF(H1I11 FOR APPLICANT TO FILL IN ceoss3sT GRl!PTD AVENUE LEGAL '?DESCRIPTION LOT NO OWNER RICHARD SCOTT BLOCK y TRACT � MAIL � ADDRESSNO OF ? T SIZE OF LOT NOW ON OTS CITY �C/ No. PJB 12268 USE OF BUILDINGS DISTRICT t ✓ V NO GR BK MAP PG PRO ESS D BY CONTRACTOR A. S. TOMICH T — ADDRESS � 7�T� n NN COECTIO DATA CITY 1 1`lr CITY TEL NO At 628�� T TION DEPTH r� REGISTRATION NO 85271 COUNTY STATE MANHOLE REFERENCE UP No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR T CURB PL M L TO P L PITS AND/OR DRAINFIELD @ 33 00 OVERFLOW SEEPAGE PIT DRAINFIELD d EXTN CESSPOOL DRYWELL @ 32 00 HOUSE SEWER CONNECTING TO ^P C NO O PRIVATE DISPOSAL SYSTEM @ S1 00 CO IMP NO JOB NO V CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO SEWER R DAIROS ABANDON SSTHOUSE @ $1 00 STATE ENCROACHMENT V PERMIT NO INDUSTRIAL 11J WASTE APPROVAL Ct to CHARGES Z OWNERS PERMITCONNECTION CHARGE FEE AUTHORIZATIONI TOTAL FEE 12REIMBURSEMENT FEE HAVE AT THDATE A CONTRACY WITH THE HEREIN NAMED CN- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLICS ER SIGNED T. DAY OF JULY 19 2 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS BUILDING OR WORK ADDRESS f ` - SEPTIC TANK SEEP PITS) 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 SYSTE I HEREBY CERTIFY THAT 1 AM PROPERLY R ISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES TY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEG OWNER OF�HE OVE BACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDENTI PE SEEP PITS Cl CESSPOOLS SIGNATURE OF PERMITTEE__ VALIDATION ROBERT A WOOD CK r o CAsx SUPERVISING MECHANICAL ENGINEER X1 ,0 5,4%=J& 2 1 1 ® 25.00- 9