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Home My Public Portal About4851 FIESTA AVE_Sewer__ 082 7GA642D APPLICATION FOR PERMIT 8A842 COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ••,:� J JOHN A LAMBIE County Encrmeer ADDRESS WILLIAM A JENSEN Sup t of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS 5T LEGAL DESCRIPTION LOT NO 37 L OWNER MAIL BLOCK TRACT s- ADDRESS NO OF SLOGS SIZE OF LOT ! v NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GR MAP PROCESSED BY t BK PG / CONTRACTOR )F o / - — T ADDRESS O /-4d J CONNECTION ECTION DATA / STATION DEPTH CITU { TEL NO �!/Ip ✓ TATE MANHOLE REFERENCE } REGISTRATION NO (^f C.+ �G� COUNTY LOWER a NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIONENGTH F M O HOUSE SEWER CONNECTING TO Y CURB PL M L TO P ' V PUBLIC SEWER @ 35 00 SEPTIC TANK SEEPAGE PIT OR P C NO Q[ PITS AND/OR DRAINFIELD @ S1000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ S300 CONNECT ADDITIONAL B LDG jm AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE N ATO HOUSE SEWER @ S300 33 0-0 Z OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOLDRYWELL MANHOLE @ $500 HWV OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ z os0CHARGES � AU'T'HORIZATION TOTAL FEE l /�// CONNECTION CHARGE 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 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 DRAT 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 ❑ 1 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 OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE A VE DE CRIBED R IOEN L PROPE TV ABANDON HOUSE SEWER SIGNATURE �"v BACKFILL SEPTIC TANKS ❑ OF PERMITT SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD M O CASH SUPERVISING MECHANICAL ENGINEER CK _ _ LACO1 8 1 1ZO" OCT 23 1 0 D 500- CE808 DD e2 APPLICAeONOR Pf 76A64IT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING I JOHN A LAMBIE County Engineer ADDRESS WILLIAM A JENSEN Sup t of Building [� Y LOCALITE m P L F C 1 NEAREST FOR APPLICANT TO FILL IN CRDSS ST 4 {� L LEGAL J O S 7 /� E T DESCRIPTION LOT NO OWNER Q ` MAIL BLOCK TRACT LJ S' ADDRESS O J r SIZE OF LOT O NOWOON LOTS CITY -re TEL NO +,S USE OF _ _ BUILDINGS 5 ( C DISTRICT NO GROUP MAP P OCE D BY PG CONTRACTOR 0 �.1� n1 E, J, Q K ADDRESS rV G CONNECTION ECTION DATA' \ CITY TEL NO STATIONi , 6 DEPTH 6 � .� STATE REGISTRATION NO ElCOUNTY MANHOLE REFERENCE 17 , LOWER NO DESCRIPTION OF WORK FEE TYPE OF CTION` LENGTH F M HOUSE SEWER CONNECTING TO Y CURB P L M L TOP PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR J C NO PITS AND/OR DRAINFIELD @ $1000 CO IMP NO OB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ S3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NOT DATE WORK TO HOUSE SEWER @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD y EXTN CESSPOOL DRYWELL MANHOLE @ 55 00 T4i / q�FR RFono--- HWY OR ST WIDENING ABANDON HOUSE SEWER Q;.-alGPABAL SYSTEM @ 53 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ z 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE CHARGES I 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 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 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED 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 RE TIAL PROPERTY ABANDON HOUSE SEWER PAD SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION � ROBERT A WOOD CK M o l/CAS /H SUPERVISING MECHANICAL ENGINEER � t,C� 7 A 7 - JJL 1 j L y D j �