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HomeMy Public PortalAbout4847 GLICKMAN AVE_Sewer__ e D CESOB-B-b8 APPLICATION FOR PERMIT 1 E808- COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Fngineer ADDRESS CASSATT D. GRIFFIN, Sup't of Building LOCALITY Tem le Cit NEAREST FNEAREST OR APPLICANT TO FILL IN CROSS ST. LOWLY' Azusa AL DESCRIPTION TION LOT N0. OWNER Edw. Winberg MAIL BLOCK A TRACT 10992 AD RESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CI TEL.NO. USE OF BUILDINGS DISTRICT N0. GROUP MAP PROCESSED BY IL BK PG CONTRACTORSquare Deal Sewer Service f L� lzm":�� ADDRESSADDREss2933 Maxs on Rd. CONNECTION DATA CITw_ TEL.N0. O S77ON / f^ DEPTH STATE REGISTRATION N0. 12 Q COUNTY MANHOLE REFERENCE (j s LOWER NO. DESCRIPTION OF WORK FEE 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. 'J V OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO Imo? P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP.NO. JOB N0. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. ZT ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. Saddle 25 100 INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT g CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE 25100 REIMBURSEMENT FEE 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. SIGNED THIS DAY OF I9_ NEW HOUSE SEWER OWNER OR �T-��7 CONNECT ADDITIONAL OWNERS AGENT plz BUILDING OR WORK SEPTIC TANK,SEEP,PITS) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT t 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 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNE OF THE ABOVE DESCRIBED RESIDENTIAL EROP RTY. BACKFILL SEPTIC TANKS❑ SIGNATURE j�!-� SEEP.PIT(S) Q CESSPOOLS OF PERMITTEE ®� ATION ROBERTA.WOOD OQ r,p, QA4E SUPERVISING MECHANICAL ENGINEER �,r ,� ©� tcu 1 i 1 D 25.00 D CE808.B-S� APPLICATION FOR PERMIT EBOB- COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING L.947 GI ickman Avp. JOHN A. LAMBIE, County Fmgineer ADDRESS CASSATT D. GRIFFIN, Supt of Building LOCALITY FOR APPLICANT TO FILL IN CROSS ST Lower Azusa LEGAL DESCRIPTION LOT N0. 7 OWNER Edw. Winber BLOCK A TRACT 10992 ADDRESS 1905 Vista Ave. N0.OF BLDGS. SIZE OF LOT NOW ON LOT 1 CIT TEL.NO. USE OF BUILDINGS Res• DISTRICT N0. GROUP MAP FROCESSED BY PQ CONTRACTORS uare Deal Sewer Service j > x 5-1 7c'-,'� ADDRESS2933Mays on Rd. CONNECTION DATA , CITYEJ 1 �} TEL.N0. 4-2020 STAT �: DEPTHSTATE REGISTRATION NO. 12$$70 ® COUNTY MANHOLE REFERENCE / j 4 NO. DESCRIPTION OF WORK FEE (9 LOWER HOUSE SEWER CONNECTING TO -3 100 PUBLIC SEWER @ $3.00 SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3.00 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 N0. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 5 00 REIMBURSEMENT FEE 1 LS HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVADATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK NEW 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 1 AM THE LEGAL OWNS OF T ABOVE DESCRIBED RESIDENTIAL P4OPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURElap SEEP.PIT(S) ❑ CESSPOOLS❑ OF PERMITTE C ®� ATION ROBERT A.WOOD „ M,C. CASK SUPRRVISING MfiCHMICAL,SNGINNER 4zG Lc:::) 149V ? 5.00