HomeMy Public PortalAbout5021 FIESTA AVE_Sewer__ &E-6D
S 63 11.55 /-APPLICTION FOR Y tl E ! ■ IIT 1
&E•6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING °-
JOHN A. LAMBIE, COUNTY ENGINEER :s ADDRESS
• 7
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY` .�
„w.:....:.-.•, - ,. NEAREST r
FOR APPLICANT TO FILL IN CRoss
LEGAL OWNER Ci
DESCRIPTION LOT N0.
MAIL
BLOCK TRACT py, _ (J' AD DRESS J� �l , A
NO. OF BLDGS.
SIZE OF LOTS NOW ON LOT CITY TEL. NO.
USE OF r �% Gq
'n
BUILDINGS ! Cr Z' /a/ZU< DISTRICT GROUP MAP
BK PG
CONTRACTOR) G �/
ADDRESS - / CONNECTION DATA
STATIONit/ DEPTH
CITY % p TEL. NO. ° 110
MANHOLE REFERENCE / UPPE
STATE
REGISTRATION NO. Cl COUNTY
NO. DESCRIPTION OF WORK FEE
/ HOUSE ES CONNECTING TO @ $3.50 v TYPE OFC E TION LENGTH FROM /' �f
PUBLIC EW
t URB M.L. TO P.L. /
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00 r
OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO. / � JOB JOB t)
EXTN.,CESSPOOL,DRYWELL,MANHOLE $2.00
HOUSE SEWER CONNECTING TO
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
OWNERSPERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE L5 0
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE IN PECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS .2 OF 19;,f 7 CONNECT ADDITIONAL
OWNER OR T BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS d AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE ftAj THIS APPLIZATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT Arfn AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REQUIRED BY LOS ANGELES CO DISCOND
TY AND STATE OF DISCONABANDON HOUSESEW D
CALIFORNIA OR THAT I AM THE LEGAL 0 NER OF THE ABOVE _
DESCRIBED RESIDENTIA ROPERTY, BACKFILL SEPTIC TANKS �/
SIGNATURE
_SEEP.PIT(S) Cl CESSPOOLS 2
OF PERMITTE -
JOHN A. LAMBIE. C TY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. B.0. KED
LAP^4 3 5 b'- JAN 21 4 4.5 0 '�
7 6 A 642D -CE808 - 1 0-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS T.
LEGAL _
DESCRIPTION LOT NO. OWNER P
— - MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY - .TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAPPROCESSED BY
BK PG
CONTRACTOR
ADDRESS CONNECTION
STATION DEPTH
CITY TEL. NO.
STATE LIC MANHOLE REFERENCE UPPER
LICENSE NO. CLASS LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $7.00
P.C.NO.
SEPTIC SEEPAGE PIT OR PNOJOB NO.
PITS AND/D/OROR CO.. . . 0
DRAINFIELD @ 510.00 O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. u
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIV[N [AS[11[NT RECORD.INSTR, NO. DATE LU
WOajZO HOUSE SEWER $3.00 -� J
W
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL. @ S5.00 >_ALTER.REPAIR OR ABANDON HOUSE
HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT
MANHOLE ® $7.00 PERMIT NO. O
INDUSTRIAL CL<
WASTE APPROVAL <'
CHARGES uj
OWNERS PERMIT $ 3 00
W
CONNECTION CHARGE FEE
AUTHORIZATION-1 TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTORTO 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 _
ADDRESS BUILDING OR WORK '� J
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP.PIT(S)
AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
WIT HALL COUNTY ORDINANCES AND STATE LA W5 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 I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE BACKFILL SEPTIC TANKS ❑ i
_"'-- SEEP. PIT(s) El CESSPOOLS ❑
VALIDATION CK, M.O. CASH
I