HomeMy Public PortalAbout5326-30 GLICKMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGLYF.ER SEWER-SEWAGE DISPOSAL 19 2 21
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES gURDING
WILLIAM J. FOX, COUNTY ENBINEER ADDRESS
v
FOR APPUCAN T FILL IN LOCALITY �o ,
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY + t DISTRICT NO. SERIAL NO. PERMIT NO.I/
NEAREST + A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO.
CONTRACTOR California Sewer Const.Co. CO.IMP.NO.
ADDRESS 1317 Colegrove Ave. JOB.NO.
CITY Wintebello TEL.NO.UNion 1-5048 TRUNK PERMIT NO.
REGISTRATION NO. 104445 S1&TTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. • PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT X O N0.OF BLDGS.
NOW ON LOT CHARGES
USE
BUILDINGS p CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO n
PUBLICSEWER @ ; 3.50 [.% RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0.
ALTER OR REPAIR EXISTING / 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/OR DRAINFIELD 2.00 STATION ��f- <.' DEPTH
CESSPOOL—DRYWELL `
SPECIAL CONDITIONS ONLY 2.00 — �-MANHOLE REFERENCE
1 y UPPER -W4CER
TYPE OF CONNECTION" LENGTH FROM
OWNERS PERMIT ;
C &_ P.L.' M.L.TO P.L.
� d'A
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TOTHEPUBLIC SEWER
SIGNED THIM_ ._.D ...
____.I NEW HOUSE SEWER J^C
OWNER OR CONNECT ADDITIONAL
OWNERS AGE N - ... .............
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS----- - - -..........----.-_.._.... ..._.........._.._......_... AND/ORDRAINFIELD
1 HEREBY KNOWLEDGE THAT I HAV READ THIS APPLI• CESSPOOL[:] DRYWELL
CATION AND STATE THAT THE ABOVE IS ORRECT 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 OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED 'ESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El j
SIGNATURE
/ n I `/ SEEP.PIT(S)o CESSPOOLS t
OF PERMITTE f // / ! _
....
76A642A 663 7/53
CE808 2/70
76,A 642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FRE
JOHN A. LAMBIE. COUNTY ENGINEER G �j
COLEMAN W. JENKINS. SUPT. OF BUILDING �p-
lli�G
FOR APPLICANT TO FILL IN ('
(PRINT OR TYPE ONLY)
LEGAL . e
DESCRIPTION LOT NO. OWNER („
MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS. /\ _
SIZE OF LOT () 3 NOW ON LOT CITY '"! TEL. NO. Q
USE OF DISTRICT NO. ROUP CL SS MAP ESSED BY
BUILDINGS
—IV /y BK P
CONTRACTOR 5�-�` C O �O 17— /
ADDRESS Q "j CONNECTION DATA
CITY CP TEL. NO. STI ON DEPTH
STATE LIC MANHO REFERENCE UPPER
LICENSE NO,13 1 CLASS LOWER
NO. 1 DESC P ION OF WORK FEE TYPE O NNECTION LENGT OM
HOUSE SEWER CONNECTING TO Y. B P.L. M.L.,MTP.L.
PUBLIC SEWER @ $5,00
SEPTIC TANK.SEEPAGE PIT OR P.C. O.
CO.IMP.NO. .
J NO
PITS AND/OR DRAINFIELD @ 510.00
HOUSE SEWER CONNECTING TOTRUNK PERMIT NO. AD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ S3.00 O
13-
"44M AFFIDAVIT w�IVEE EASEME RECORD.IN .NO. DATE V
WORK TO HOUSE SEWER @ $3.00 Q 4J
OVERFLOW SEEPAGE PIT,DRAINFIELD ce
E%TN..CESSPOOL.DRYWELL,MAN HOLE @ $5.000
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WI NING
H
SEWER OR DISPOSAL SYSTEM @ $3.00 STATEENC ACH MENT U
PERMIT Lu
INDUSTRIAL
I WASTE APPROVAL Z
0WAAA9 PERMIT $ '� 00 CHARGES
AUTHORIZATIONT TOTAL FEE / CONNECTION CHARGE FEE
n.
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIB D EXISTING DWELLING
TO THE PUBLIC SE E APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS )AY F n 1921�.
OWNER OR / NEW HOUSE SEWER
OWNERS AGENT L
. Ii CONNECT ADDITIONAL
ADDRESS .F+�i Il` BUILDING OR WORK
SEPTIC TANK,SEEP,PITS)
I HEREBY ACKNOWLED THAT 1 HAVE READ THIS AP LICATIO AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CE POOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALT REPAIR.SEWER OR f
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF AGE DISPOSAL SYSTEM
CALIFORNIA OR THAT^I AM THE LEGAL OW ER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABO f E DESCRIBED;riD15 (TIAL PROPERTY. ABANDONHOUSESEWER
c
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP.PITS) ❑ CESSPOOLS ❑
f
�rs�ALM.0. CASH JACK R. ALLEN
{� SUPERVISING MECHANICAL ENGINEER
CK. M.O.
e( ��
L nU0 r 8 �i I Inl 4 1 0 D. 6.0 /�V e.