HomeMy Public PortalAbout9168 FORTSON DR_Sewer__ ' 10
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CESOS-8-08 APPLICATION FOR PERMIT
E808•e �.
COUNTY OF LOS ANGELES I SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. LAMBIE. County Engineer ADDRESS 168 Fortson Dr.
CASSATT D. GRIFFIN, Sup't o4 Building LOCALITY Tem e'Cit
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. .
LEGAL OWNER H. -M.- Holtz -
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE OF } T
BUILDINGS DISTRICT NO. GROUP MAP P OCESSED BY
BK PG
CONTRACTOR Belvedere Plumbing Co'. �7 .Q
ADDRESS 11900 E. Garvey Ave. CONNECTION DATA
CITY TEL.NO. STATION DEPTH-
STATE
REGISTRATION NO. 17 9568 COUNTY MANHOLE REFERENCE UPPER
NO. DESCRIPTION OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO.
PUBLIC SEWER @ $8,00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $8.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
1 WORK TO HOUSEISEWER BLDG.OR @ $1.00 1 0o TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00' . PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
` AUTHORIZATION I TOTAL FEE 3 00 REIMBURSEMENT FEE l
I HAVE AT,THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SsIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. v
SIGNED THISnA]� OF !9_ NEW HOUSE SEWER le
OWNER OR p AA /1j /� CONNECT ADDITIONAL' �9
OWNERSAGEN6"-L � ti BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD &f
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRY-WELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR ASV N/
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS AZLEGOUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA THAT I AM THEWNER OF T E•ABOYEDESCRIBED NTIAL PROPERTYBACKFILL SEPTIC TANKS❑
SIGNATOR
SEEP.PITS) ❑ CESSPOOLS❑
OF PERMI
®►
gATION ROBERT A.WOOD
g,p, Quit SUPERVISING MECHANICAL.ENGINEER
LrL� F 1 0 1 v D 3 .00
76A642D
.,5@E.66312.54 APPLICATION FO PERM IT - 1.
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING /k k �,.�
WM. J. FOX, COUNTY ENGINEER _
` CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY _ - } � •' <<
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. +�- �•.. �
LEGAL
DESCRIPTION LOT NO. ✓✓ OWNER. \j ,
BLOCK TRACT / J •� •MAIL
ADDRESSNO OF
a�'�' � J rel
SIZE,OF LOT NOW ONBLOTS f TEL. ! � �
USE OF- pp I
BUILDINGS i �'�'lJ DISTRI T NO GROUP MAP
PG
CONTRACTOR ! 4&tt A' I 7 I B� .—
ADDRESS I ..�/�! �!�� X ✓ CONNECTION DATA
•Cr J _
CIT 1/� y TEL. N _ Vb STATION �G� ��• DEPTH �p
�0 � STATE /.� pN OLE REFERENCE
REGISTRATION N0.- ❑ COUNTY (p(pr J /'�: G7A UPPER
TYPE OF CONNECT( LENGTH FROM l -
NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L. �0
HOUSE SEWER CONNECTING TO - -
'PUBLIC SEWER - c@:$ 3.50 cY"
HOUSE SEWER CONNECTING TO T _
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO, !•� b I JOB. N0.
WORK TO HOUSE SEWER 1.00
ALTER.OR REPAIR EXISTING -
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. - ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE EN CROAC
AND/OR DISPOSAL SYSTEM 1.00 ,PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
--PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
- CONNECTION CHAR FEE
.OWNERS PERMIT $ I 1 00
AUTHORIZATION TOTAL FEE - REIM UR ENT FEEIHAVE -
MED CON-
TRACTORTTOS CONNECDATE T THEA ABOVE WDESCRBED EXISTING ITH THE HEREIN A DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE'PUBLICSIE.�WER
/
SIGNED THIS�DAY F_� 1 NEW HOUSE SEWER
OWNER OR i / f _ CONNECT ADDITIONAL' •, -
OWNERS AGENT BUILDING OR WORK
ADDRESS + // '�*-- �� /,I�i�( SEPTIC-TANK, SEEP,-PIT(S)
AND/OR DRAINFIELD
I HERE Y A kNOWLEDGE THAT I HAVE READ THIS P (CATION 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 DISCONNECT PLUG AND-
CALIFORNIA.
CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF '
CALIFORNIA.OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON-HOUSE SEWER
DESCRIBED,RESIDENTIAL PROPERTY. - // BACKFILL SEPTIC TANKS❑ •,�
/ SEEP. PIT(S) ❑ CESSPOOLS / A./'� /i •r
SIGNATURE !
OF PERM ITT 1��+ / - -
1' '
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
DEPUTY ;j DEPUTY `
BY BY
® DEPUTY• DEPUTY