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Home My Public Portal About4834 GLICKMAN AVE_Sewer__ 0-63 76A642D APPLICATION FOR PERMI � 6A642L1 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING •� y �- /rte JOHN A. LAMBIE, County Engineer ADDRESS W WILLIAM A. JENSEN, Sup't of Building �- LOCALITY L..+ NEAREST FOR APPLICANT TO FILL IN CROSS ST.LEGAL -DESCRIPTION �a t—✓� DESCRIPTION LOT NO. J� �y �j' J4 OWNER BLOCK TRACT /D ! 9 G O��/ /3 MAIL +� �7 f�IBLDGa�q ADDRESS SIZE OF LOT C®JG�J NOWOON LOTS CITY TEL NO. USE OF ' DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS V gf� /P—G — CONTRACTOR ��✓ / //f, v ADDRESS `�j �� `�/' �!` CONNECTION DATA CITY �.• TEL. N V STATION -71-G,/. DEPTH y� ♦ /MANHOLE REFERENCE 9 �'i ! UPPE REGISTRATION NO. (f:> Z ❑ COUNTY ` v a�rrw NO. DESCRIPTION OF WORK FEE ypE F/ N NECTION LENGTH FROM HOUSE SEWER CONNECTING TO �uG('/ RB P.L. M.L.TO P.L. O PUBLIC SEWER @ $5'00 /2 Z1' JOB NO. O SEPTIC TANK,SEEPAGE PIT OR CO.I f c..i PITS AND/OR DRAINFIELD @ $10.00 V HOUSE SEWER CONNECTING TO TRU K P R XT NO. %�F�/' ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CCJ CONNECT ADDITIONAL BLDG.OR �O AFFIDAVIT WAIVER I E1SEM11Ii I REC, RD.INSTR.NO. DATE O WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD W EXTN.,CESSPOOL,DRYWELL,MANHOLE.@ S5.00 h ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT Z PERMIT NO. INDUSTRIAL r WASTE APPROVAL CHARGES OWNER'S PERMIT $ 2 00 AUTHORIZATION TOTAL FEE O CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF Z 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT / ' CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK;SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL El IHEREBY CERTIFY THAT I AM PROPERLY REGISTER AND/OR ALTER,REPAIR,SEWER OR LICENSED AS RE20TCRIOBED S ANGLES COUNTY A STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR LEGAL R OF, D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE R TIA P 0PERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ SEEP.PIT(5) ❑ CESSPOOLS VALIDATION ROBERT WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. GASH LiCo JM161 0 D 5.00cv ,D_82 76A642D APPLICATION FOR PERMIT 76A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING � JOHN A. LAMBIE, County Engineer ADDRESS ✓/ WILLIAM A. JENSEN, Sup't of Building LOCALITY,�� NEAREST FOR APPLICANT TO FILL IN CRosB BT. ,i LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ` G ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS w/J� DISTRICT NO. G/R/OyU//g MAP PROCESSED BY PG CONTRACTOR51 ADDRESS/_n ';1__*r / CONNECTION DATA ` EL. NO.�/J /� S T N J DEPTH CITY T/ ? ^T REGISTRATION NO. l �(Q /� El COUNTY MANHOLE REFERENCE U NO. DESCRIPTION OF WORK FEE T E OF CO CT LENGTH ROM V HOUSE SEWER CONNECTING TO Y. ,P�L� M.L.TO I.L. PUBLIC SEWER @ $5.00 JIM P.C.NO. SEPTIC TANK,SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $3.00 TRUNK PERMIT NO. ROAD PERMIT NO. C CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD _ EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL 5 TEM @ S3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL C jam/ WASTE APPROVAL J sL11/(6• CHARGES OWNERS PERMIT � AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSEDAS REOUIR BY LOS ANGLES C AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH I A THE LEGAL O R OF, D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A E D SCRIBED E IAL PERTY. gBAN DON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ElOFFPERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ CK.VALIDATION ROBERT A. WOOD M.0. CASH SUPERVISING MECHANICAL ENGINEER 1U_82 76A642D APPLICATION FOR PERMIT ��?/ 78A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building T LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS sT LEGAL i DESCRIPTION LOT NO. OWNER �J MAIL BLOCK /,--5- TRACT zo ADDRESS NO. OF ALDdS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PG PROCESSED BY CONTRACTOR/ ��,/ J� ' (1 4 t BKS ADDRESS A' 1 COQ//`N(NECTION DATA 5 A ION DEPTH (� CITY TEL. NO. ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO. El COUNTY NO. DESCRIPTION OF WORK FEE PE OF N O LENGTH F#15M HOUSE SEWER CONNECTING TO �-'P Y. P.L. M.L.TOP , PUBLIC SEWER C� $5.00 C' l.' P.C.NO, O SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. T O PRIVATE DISPOSAL SYSTEM @ $3.00 ! CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL �'__' WASTE APPROVAL OWNERS PERMIT $ z 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE If I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGNATURE SIGNED THIS DAY OF _19- OWNER 9_OWNER OR NEW HOUSE SEWER - OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERL STEREO AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY D STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT M THE LEGAL O ER OF, AN INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AS E ESCRIBED RES IAL P RTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER �_ 1