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HomeMy Public PortalAbout4825 FIESTA AVE_Sewer__ Tom'm p 1,�q C l 10 63 76A642D APPLICATION FOR PERMIT 6A64 , LI COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS WILLIAM A JENSEN Supt of Building /� p LOCAL TY �4 \ , NEAREST FOR APPLICANT TO FILL IN CROSS 57 LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO O BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO I GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTO .Q I'C �/ E ADDRESS ¢ /� ` CONNECTION DATA CITY TEL NO !111 '111,a�(/1} ON DEPTH / t.S UPPER T � COUNTY `J e O REGISTRATION NO MANHOLE REFERENCE NO DESCRIPTION OF WORK FEE PE OF ON ON LENGT ROM HOUSE SEWER CONNECTING TO Y P M L T L IL PUBLIC SEWER lid E5 00P C NO O SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO V PITS AND/OR DRAINFIELD @ SIOOO ,^ HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM E3 00 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT [7=R0 INSTR NO DATE WORK TO HOUSE SEWER @ S300 W OVERFLOW SEEPAGE PIT DRAINFIELD a EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 H HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE Z SEWEROR DISPO A YS EM @ S3 00 STATE ENCROACHMENT 1 PERMIT NO �" 4� ✓ INDUSTRIAL WASTE APPROVAL CHARGES OWNER S PERMIT a AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE REIMBURSEMENT FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 6 19_ OWNER OR v !J N NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT 1 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 ❑ 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 THATA AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE A O DESCRIBE IDENTIAL PROPERTY ABANDON HOUSE SEWER f ! 5 SIGNATURE r I BACKFILL SEPTIC TANKS El OF PERMJTTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER M O CASH GLAL,0 5 7 7 91 NOV 12 1 1 D 2 5.0 0 4 N 1 76AB42D 063 APPLICATION FOR PERMI A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISP SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS Q WILLIAM A JENSEN Sup t of Building LOCAL TY NEAREST 17 FOR APPLICANT TO FILL IN CROSS ST LEGAL I OWNER S /7 11 ✓' DESCRIPTION LOT NO s MAIL BLOCK TRACT ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF t DISTRICT NO GROUP BK PG MAP PROCESSED BY BUILDINGS CONTRACTOR S,� ���C. _1� L.' •� .r2 ADDRESS ��/�,I�Q) Q IV CONNECTION DATA CITY ea/�''�1�Y'L ,i T L NOTy Y `�S / ION DEPTH C� � STATE UPPER REGISTRATION NO L • • / COUNTY MANHOLE REFERENCE (/L NO I DESCRIPTION OF WORK FEE TY OF C NEC LENGTH FTM HOUSE SEWER CONNECTING TO /y/) Y L M L TOP L PUBLIC SEWER ® $5 00 (/ P C NOCL SEPTIC TANK SEEPAGE PLT OR CO IMP NO JOB NO O PITS AND/OR DRAINFIELD $10 00I U HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wA1111 11Sr MCNT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ $3 00 V OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 N ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT Z PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 4 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO COVNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUS BLIC EWER DATE INSPECTOR S SIGNORE SIGNED THIS DAY OF 19_ pA P OWNER OR ` NEW HOUSE SEWER * OWNERS AGENT CONNECT ADDITIONAL ( r f BUILDING OR WORK ADDRESS SEPTIC TANKSEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR ORAI NFIELD 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 CERTIF T T I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REOU E BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH AM THE LEGA OW ER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE A E D CRIB D R NTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS SEPTIC TANKS ❑ OF PERMITTEE l SEEP PIT(S) ❑ CESSPOOLS ❑ / VALIDATION ROBERT A WOOD l/�, SUPERVISING MECHANICAL ENGINEER CK M O CASH 5 7 7 8%Z NOV 12 1 0 D 7,0 Q 17 f 76A64 2D 0 63 APPLICATION FOR PERMIT A64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIN JOHN A LAMBIE County Engineer ADDRESS G WILLIAM A JENSEN Sup It of Building LOCAL TY NEAREST FOR APPLICANT TO FILL IN CROs. ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT //�_ ADDRESS ' NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USEOF DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS LamBK PG CONTRACTOR `:^©y r — �IV ADDRESS . CONNECTION—DATA CITY TEL ST I N 1 3 DEPTH EY ATEUPPE REGISTRATION NO ❑ COUNTY MANHOLE REFERENCE NO DESCRIPTION OF WORK FEETYP FC N T N LENGTH M r HOUSE SEWER CONNECTING TO 100 :"Cl 1 Y P L M L TOP ! PUBLIC SEWER SS 00 SEPTIC TANK SEEPAGE PIT OR PC NO O PITS AND/OR DRAINFIELD Q S1000 CO IMP NO l �j JOB NO /� L) HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO/ X ix PRIVATE DISPOSAL SYSTEM @ 53 00 U 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE V WORK TO HOUSE SEWER @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST N G h SEWER OR DISPOSAL SYSTEM @ S3 00 STATE ENC ACH MENT PERMIT NO INDUSTRIAL C WASTE APPROVAL CHARGES OWNERS PERMIT S z o0 AUTHORIZATION TOTAL FEE O CONNECTION CHARfj FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSE NT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER PPR S DATE INSPECTOR S SIGNATURE SIGNED THIS �-DAY OF 19_ OWNER OR /F NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONA BUILDING OR WO ADDRESS SEPTIC TANK EP 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 LTHELEG:AL,0,WNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE A E D IAL P O RTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE EP PITIS) ❑ CESSPOOLS ❑ VALIDATI N ROBERT A WOOD CK M o GASH SUPERVISING MECHANICAL ENGINEER L�Cc) 5858Izz" NOV 131 0 D 700- lk f0 63 76A642D APPLICATI N FOR PERM T 6A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS E r WILLIAM A JENSEN Sup t of BuElchng �+ LOCAL TY l� 1 NEAREST FOR APPLICANT TO FILL IN CROS LEGAL DESCRIPTIONLOT NO OWNER MAIL BLOCK TRACT /�L�C�j ADDRESS J NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS T BK G CONTRACTOR ADDRESS CONNECTION DATA a CITY TEL STA I N 6:3 DEPTH REGISTRATION NO COUNTY MANHOLE REFERENCE r 1 LAR NO DESCRIPTION OF WORK FEE E F C N T N v LEN H OM HOUSE SEWER CONNECTING TO Y P L M TO P L /o rL PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR 141 (-0 '!/ P C O O PITS AND/OR DRAINFIELD @ $1000 CO IMP NO �-+ JO NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO R AD PERMIT NO / SOB Ax PRIVATE DISPOSAL SYSTEM @ $3 00 U 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER I EASEMENT I RE ID INSTR NO I ATE WORK TO HOUSE SEWER @ S300 U OVERFLOW SEEPAGE PIT DRAINFIELD IJJ EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR D N N SEWER OR ISP S SYSTEM @ $300 STATE ENCROACHMENT l) ©v PERMIT NO �( INDUSTRIAL WASTE APPROVAL C RGES OWNER S PERMIT $ AUTHORIZATION TOTAL FEE � CONNECTION C A GE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBU RS T�) E TRO ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING A R Y L TTHE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR W HOUSE SE E OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEPP (S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIEL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL RYWELL ❑ 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 T M THE LEGAL O ER OF AN INTEND TO DISCONNECT PLUG AND RESIDE IN THE OV DESCRIBED R TIA PR ERTY ABANDON HOUSE SEWER SIGNATURE CKFILI SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT 5) ❑ CESSPOOLS ❑ VALIDATIO ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH, LtCo 5 8 NOV 13 1 1 D 2 5 0 0 r c. 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