HomeMy Public PortalAbout4939 GLICKMAN AVE_Sewer__ 1
76AS42D
CES08.6+56 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 7ADIR
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building FOR APPLICANT TO IN 21--a
LEGALDESCRIPTION LOT NO. �y� �/��✓�G/a!
BLOCK TRACT MAIL
ADDRESS
`! N0 F GS.
SIZE OF LOT �, 0 LOT CITY ry EL.N0.
USE OF
BUILDINGS DISTRICT JNO -6koup MAP P OCESSED BY
CONTRACTOR' � ' v � j �P G
ADDRESS � ,. �,r���� COfN�N'ECTION DATA
TEL.N0. ,yl STATION
11-e oy-a0 DEPTH
[� TAMANHOLE REFERENCE L A, UPPER
TE
REGISTRATION N0, � ,3Q� ❑ COUNTY OWER
NO. DESCRIPTION OF WORK FEE.
HOUSE SEWER CONNECTING TO
�. PUBLIC SEWER @ $8.00 /7 L3 TYPE OF CO ECTION LENGTH FROM-
SEPTIC TANK,SEEPAGE PIT OR Y. CUR P.L. M.L.TO P.L. L�,JJ''
PITS AND/OR DRAINFIELD @ $5.00
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.
CONNECT ADDITIONAL BLDG,OR TRUNK PERMIT NO.' ROAD PERMIT N0, ��
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM- @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERNIIT Z 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COR. APPROVALS DATE INSPEC OR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEIX
rJ%¢-
SIGNED THIS 13AY OF �'� I ' NEW HOUSE SEWER Y'
OWNER OR / / CONNECT ADDITIONAL
OWNERS AGENT GaleBUILDING OR WORK
ADDRESS ✓'�� SEPTIC`TANK,SEEP,PIT(S)
AHD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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 RESIDENTIA ROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) [I CESSPOOLS❑
OF PERMITTE f
®e AIMATION ROBERT A.WOOD
Car Y.Q. CASK SUPERVISING MECHANICAL,ENGINEER
tr
w-DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS `
C"
FOR APP A T T FILL IN LOCALITY
BUILDING //c. q � NEAREST
ADDRESS / CROSS ST. 4yr A
LOCALITY /c/k DISTRICT No.
A SERIAL NO. PERMIT NO.NEAREST
e
GROSS ST. Q d G_.� SYJ7f- S
r RE QIVED BY Ready for Inspection DATE ISSUED
OWNER IV
MAIL
ADDRESS �� t r f Ai C(�� USE ZONE OCCUPANCY MAP
/ llr f` BKPG
CITY Z, A , TEL.NO.
CONTRACTORa h � [it( 6,
CO.IMP.N0.
ADDRESS 494) �,1. f Q '/- JOB NO.
CITY /41%% fV7 O r-44 TEL.NO. e,2113 TRUNK PERMIT NO.
STATE
REGISTRATION NO. H COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT N0.8F BLDGS. WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS A' <r6/
/'v g CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
13LIC_SEWER Q $ 3.50 RECEIPT NO. ( DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
_ PITS AND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS I PERMIT 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE I a:_`>
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS-------------------DAY OF.....................................19...--.- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OW N ERS AGENT................•............................................................... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS - - ----------------------------------•----•--------------•-- AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA Of/pRR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE D Cr� a RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE � E]EEP.PIT(S) CESSPOOLS,
OF PERMITTE --------------------------- -
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