HomeMy Public PortalAbout9819 FLAHERTY ST_Sewer__ &E-6D69 11.55
S -APPLICATION FOR PERMIT
E-6
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer -
(qounty. of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS _
® 'CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY (�
M 4.iD
FOR APPLICANT TO FILL IV CRST
OSS ST.-
LEGAL• ! �� ,( S Q OWNER 9-
DESCRIPTION LOT NO. J SIJ -
- MAIL Cy 6� `-
BLOCK Q TRACT 8- b— '3 ADDRESS�U DNO. OF U
SIZE OF LOT&)-A 1-3) NOW ON LOTS ie CITY TEL. N . m
USE OF
BUILDINGS A.-p— DISTRICT NO. -GROUP . MAP
BK PG
CONTRACTOR AA(Jux:3 -.5 _ =
ADDRESS -! S qr� - ' CONNECTION DATA
�3
STATION DEPTH '
CITY . a - TEL. N0. -1 ®a1A§,g
MANHOLE REFER NCE UPPER
s ,
El STATE LOWER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF•WORK FEE -
HOUSE SEWER CONNECTING TO .TYPE OF NNECTION _ LENGTH FROM
Y. C RB P.L. TO P.L.
-PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0. -
i EXTN.,CESS POOL,DRYWELL,MANH0LE @ $2.00 CO. IMP. NO. _JOB NO.
HOUSE SEWER CONNECTING TO .
.PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMITye'000r
ROAD PERMIT NO._
/ CONNECT ADDITIONAL BLDG.ORSTATE ENCR CHMEN,T _ -
WORK TO HOUSE-SEWER - @ $1 00 OD PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTR L
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE A PROVAC
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 00
AUTHORIZATION. TOTAL FEE REIMBURSEMENT FEE' C..
I HAVE AT THIS'DATE A CONTRACT WITH THE'HEREIN'NAMED CON APPROVALS DATE INSPECTOR'S SIGNATURE
-TRACTOR TO CONNECT ,THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. �I�/ NEW HOUSE SEWER - -
SIGNED THIS D OF 19_U!^ CONNECT ADDITIONAL / 1
OWNER. OR' 0 BUILDING OR WORK -3 " ��j D '
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS S AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ •DRYWELL❑ -
AND STATE THAT THE,ABOVE IS CORRECT AND 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 AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 'STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I, AM THE LEGAL 0EOF THE ABOVE
DESCRIBED RESIDENTIALOP RT r BACKFILL SEPTIC TANKS•❑
SIGNATURE SEEP.PIT(S) El CESSPOOL ❑
OF PERMITTEE
JOHN A:LAMBIE. COUNTY ENGINEER VALIDATION�a ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N. O.
LtC,o.7•5 2 4 IMAR 9 1 0 A 3.0 U ° .
76AG4213 APPLICATION FOR P E FN I T
S&E-663 11.55
DIVISION'OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL -
Department of County Eagfaeor
• County of Los Angeles BUILDSS
ING
`
JOHN-A LAMBIE, COUNTY ENGINEER
T) -- CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT T FILL CR S s.
LEGAL
DESCRIPTION - LOT NO. . OWNER _
- MAIL
BLOCK - TRA'CT [['//••��. / ADDRESSNO. OF r-
SIZE OF LOT/� e/^LJ NOW ONBLOTS / CITY TEL. NO.
USE OF - DISTRICT ROUP MAP
BUILDINGS
_ BK PG f
CONTRACTOR
ADORES CONNECTION DATA
9-1 / STATION * �i DEPTH d-
CITY NO. MANHOLE REFERENCE. J PPER`
REGISTRATION NO. Gf ❑ COUNTY - ,
No. DESCRIPTION Of WdRK 666 FEE
TYPE OFC ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y- tB P.L. M.L. TO P,
L. I �,
PUBLIC SEWER @ $3.50 _ _
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00,
OVERFLOW SEEPAGE PIT,DRAINFIELD ' �1 P, C. N0. -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO. IMP. NO.- .7 10B N0.
HOUSE SEWER CONNECTING TO - �O ^ /,
PRIVATE DISPOSAL SYSTEM @. $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. Q,( y
CONNECTADDITIONALBLDG.OR STATE ENCROACHMENT
WORK TO-HOUSE SEWER @ $1 00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL-
' SEWER OR DISPOSAL SYSTEM Q $1.00, WASTE APPROVAL - -
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00'
AUTHORIZATION TOTAL FEE D REIMBURSEMENT,FEE _.
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- APPROVALS_ DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
TO THE PUBLIC SEWER. (��^--� NEW HOUSE SEWER z`�✓�'' �� � -
SIGNED THIS DAY OF f– 1967 CONNECT-ADDITIONAL
OWNER OR. `' - - BUILDING OR WORK
OWNERS AGE SEPTICTANK,.SEEA,PITS) '
ADDRESS 'r AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE AD THX APPLICA CESSPOOL❑ DRYWELL❑ '
AND STATE.THAT THE ABOVE-IS CORRECT--AND AGREE TO CO I
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE-DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I SAM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
-
CALIFORNIA 0 THAT I AM E LEGAL WNER OF 7H E C -
-DESCRIBED RENTIAL PRO T - BACKFILLTANKS
SEEP.PIT(SE) CESSP.00❑ • -LS2-I S.p rJ. �D
SIGNATURE ..
OF PERMITTEE
JOHN A. LAM BIE. OUNTY ENG EER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.O. CASH
i AiCo 1. v FEB-14- 4 . 4.5 0 �'