HomeMy Public PortalAbout9174 FORTSON DR_Sewer__ •76A642D Y-\Y ■ ��VI"' TION, FOR ■ O.■ MIT
• 5&E•663 12.54
DIVISION 1-
OF BUILDING-AND SAFETY SEWER-SEWAGE D I S PO SA L
Department of County Engineer
County of Los Angeles BUILDING v
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
HERM
FOR APPLICANT TO FILL IN CROSS ST. t
LEGAL 6,43 OWNER
_DESCRIPTION LOT NO.
BLOCK TRACT C.� "1 MAIL
N0. OF BLDGS. 1}��
SIZE OF LOT NOW ON LOT, r C 1 °' TEL, NO.
USE OF,
BUILDINGS � DISTRICT GROUP MAP
/�• BK PG
CONTRACTOR c
CONNECTION DATA
CITY IN TEL. NO. STATION �/ „�1�. DEPTH
_ STATE MANHOLE REF ,t2C�• ,
J(��
LOWER
COUNTY WB
REGISTRATION,NO. l ' 1,✓/� ❑ TYPE OF CONNECT LENGTH FROM O
No. DESCRIPTION OF WORK FEE Y. CURB. P.L. M.L.TO P.L.
•HOUSE SEWER CONNECTING TO D
PUBLIC SEWER @ $ 3.50-
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. ` JOB. NO.
_ 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 ENCROACHTT
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 HARG
_ CONNECTION CHAR EE
O'V`INER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE' . lim REIMBU ENT FEE
TRACTORHAVE T TO CONNECTHIS DATE ONTRTHEA ABOVE DESCR BEDCTED WITH THE HEREIEXISNINGA NAMDWELLING APPROVALS DATE INSPECTOR'S�� SIGNATURE
TO THE PUBLIC SEWER NEW HOUSE SEWER -z
SIGNED THIS %F 19 LNC'
OWNER OR G '7 CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRES9 AND/OR DRAINFIELD
I HERE Y AC NOWLEDGE HAT 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 OWNER OF THE ABOVE
DESCRIBED RESIDENTIA P PERTY. BACKFILL SEPTIC TANKS❑ /
• SEEP.PiT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITT 22
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
I BY ._.'�O 5 9 8 9'1- JJL 2 6 4 4.50
DEPUTY DEPUTY
-a BY - - - - - -- -- - - BY - -
='® DEPUTY DEPUTY
L
Job 473
78A8420 APP'LI:CATIOM FOR :PERMIT•
CE808.8.88 -
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY'ENGINEER
BUILDING AND SAFETY-DII�ISION' BUILDING' l Fortson,
ADDRESS. ` 9174
JOHN A. LAMBIE, County Engineer'
CASSATT D. GRIFFIN, Supt o4 Building LOCALITY Tem le Wilt,
FOR APPLICANT .TO FILL IN, CROSS sr. Loma
LEGAL, OWNER BQC}Kee '
DESCRIPTION LOT N0.
BLOCK TRACT J 3`9 MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OF 'mdm�j
BUILDINGS DISTRICT NO. GROUP MAP~ PROCESSED BY
BK P6
CONTRACTOR Belvedere Plumbin Co. ��
ADDRESS 11900 E. Garvey ,Blvd, . CONNECTION DATA
CITY '.P]- Monte TEL.NO. GI 89836 , STATION .1 DEPTH
pp MANHOLE REFERENCE STATE UPPER
REGISTRATION N0. 1,79568 COUNTY - - - LOWER
NO. , DESCRIPTION OF WORK FEE _
HOUSE SEWER CONNECTING TO C!� A 1-4 ,3
PUBLIC SEWER @ $3.00 E OF CONNECTION LEAGTH FROM
PITS AND/OR DSEPTIC RAT GELD
OR @ $3 00 Y. CURB P.L. L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD - - -
EXTN-.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO JOC. NO.
PRIVATE DISPOSAL SYSTEM $1.00 CO.IMP, NO. B NO.
1 WORKETOCONNCTHOUSEISEADDITONWER LDG.0 1 OO TRUNK PERMIT NO: R PERMIT NO.
SEWER OR DISPOSAL SYSTEM HOUSE @'$1.00 STATE ENCROACHMENT
'PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
:OWNER"S PERMIT i 2 00 ' CONNECTION CH GE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN-NAMED CON. .APPROVALSDATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT, THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED`THIS DAY OF 9_ NEW HOUSE SEWER
OOWNER OR WNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK U _ .C✓J`
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD,
1 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 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 OWNER OF THE,ABOVE
DESCRIBED RESIDEN IAL PROPERTY. BACKFILL SEPTIC TANKS❑
i
SIGNATURE SEEP:PIT(S) ❑ CESSPOOLS❑
1
OF PERMITTE
®r /'-)VALIDATION, ROBERT A.WOOD
CK. N.01 CASH SUPERVISING MECHANICAL ENGINEER
GCT'1..6 1 d A 3.0 0 "
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