The URL can be used to link to this page

Home My Public Portal About5028 FIESTA AVE_Sewer__ 24650 INSERTS 7GA642UB0 APPLICATION LICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING -y ADDRESS (V/?a � JOIiN A L JMBIE County Engw r n WILLIAM A ENSEN Sup t of E LOCALITY l NEAREST / FOR APPLICANT TO FELL s CROSS ST C- LEGAL DESCRIPTION LOT NO sZ46 143 S#D F OWNER � � MAIL BLOCK TRACTv b� R '�`^ / AD DRESS 6-36 NO OF r SIZE OF LOT NOW ON LOTS CITY TEL NO USE OF DISTRICT NO GRMAP PROCESSED BY BUILDINGS ./OUP' BK PG CONTRACTORoff-&) tEi f .S ADDRESS �( GSC S/ CONNECTION DATA CITY TEL NO 9 STATION J DEPTH ^7 : Iq 37 STATE MANHOLE REFERENCE / UPPE REGISTRATION NO / No I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO 0D PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L �— PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO P C NO O PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR FL WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO Q V SEWER OR DTER ISIR POSAL SYSTEM OR ABANDON HOUSE @ $100 STATE ENCROACHMENT P4 PERMIT NO Q INDUSTRIAL ] WASTE APPROVAL WM CHARGES OWNERS PERMIT 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE CON TRACTOR TO CIONNECT THE ABOVE DESCRIBED EX STDATE A CONTRACT WITH THE IINGAMED DWELLIING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER �+ SIGNED THI JDAAl O0 Il 19_ NEW HOUSE SEWER //A� 7�Wi`�r�'yrlAQ rr- 'LA+s! OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK - ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD I 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 SYSTEM I HEREBY CERTIFY THAT 1 P ERLY REGIS ED, D R DISCONNECT PLUG AND LICENSE UIRED BY S E ESNTY NO $ ATE OF ABANDON HOUSE SEWER CALIF NIA OR T I A T LE A ..EROF T A VE DESC IBED RESIDEN L P OPE BACKFILL SEPTIC TANKS ❑ SIGNA E SEEP PIT(S) ❑ CESSPOOLS ❑ OF PER ®P ALMATION ROBERT A WOOD CR. m 0 CASH SUPERVISING MECHANICAL ENGINEER LCC P- 9 NOV 22 i 0 D 500 24650 INSERTS y lCE808880 APPLICATION FOR PERMIT 78A842D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONBUILDING r? ADDRESS C/ i JOI�i A LAMBIE County En ear WILLIAM A JENSEN Sup t of Building LOCALITY FOR APPLICANT TO FILL IN CROSS s L LEAL ca DESCRIPTION LOT NO S Io 3 �5 OWNER BLOCK TRACT MAIL ADDRESS � t V� t NO OF SIZE OF LOT 6 2.s k 10;& NOW ON LOTS CITY e TEL NO USE OF BUILDINGS DISTRICT NO GROyyyppp I MAP PG PROCESSED BY CONTRACTOR ADDRESS C—&`7 77 '� CONNECTION DATA CITY r Q TEL NO 6 STATION EPTH REGISTRATION NO / STATE MANHOLE REFERENCE i c P!N� NO DESCRIPTION OF WORK FEE HOUSE ER SEWS CONNECTING TOt PUBLIC @ $3 00 OQ TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM @ $100 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO W WORK TO HOUSE SEWER @ $1 00 0 U ALTER REPAIRSEWER OR DISPOSAL SYSTEM R ABANDON HOUSE @ $1 00 STATE ENCROACHMENT PQ PERMIT NO p INDUSTRIAL 2 WASTE APPROVAL w CHARGES OWNER S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE IHAVE AT THIS DATE A CONTRACT WITH THE NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXRSIIJNG DWELLING APPROVALS DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER y SIGNED THIS DA O 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGE z BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I 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 SYSTEM I HEREBY CERTIFY T ROPE R IST A D/OR DISCONNECT PLUG AND LICEN REQUIRE BY A GE COU TY ST E OF ABANDON HOUSE SEWER ` CALIF RNIA THAT I AM HE L OW ER F TH ABOVE DESCR BED RES ENTI L PRO RT BACKFILL SEPTIC TANKS ❑ SIGNAT SEEP PIT(S) ❑ CESSPOOLS ❑ OF PERMI ®� ATION ROBERT A WOOD C6 Y o CASH SUPERVISING MECHANICAL ENGINEER i t