HomeMy Public PortalAbout4850 GOLDEN WEST AVE_Sewer__ D
CE808-e•as APPLICATION FOR PERMIT 1
eaoe• COUNTY OF LOS ANGELESi
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING .yy, —
ADDRESS - C/
JOHN A. LAMBIE, County Engineer +
CASSATT D. GRIFFIN. Sup't of Building LOCALITY -to
NEAREST
OR AN T IN CROSS ST
LEGAL
DESCRIPTION v LOT N0. OWNER
BLOCK TRAC!�Uj��g. MAIL z I i
ADDRESS �] `4 +
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL.N0.
USE OF
BUILDI DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONT A 1
ot
ADORES " CONNECTION DATA
CITY "� y� TEL. NO. STATION DEPTH
+{ +� �� STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. (p ^ / COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTIO L TH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB ,L. .L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. B N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROA PERMIT NO.
WORK TO HOUSE SEWER $1.00
SEWER OR D1IRO R SYSTEM HOUSE @ $1.00 STATE ENCROACHME
PERMIT N0.
INDUSTRIAL
WASTE APPRO
CHARGES
OWNEWS. I PERMIT f 00 CONNECTION CHARGE FEE
AUTHORIZATION 1 TOTAL FEE 'V 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 AY OF 1g_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(SY -
ADDRESS D/�.DAILEhp._ ''._ '..• -... .
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
1 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 TH T I AM T LEGAL OWNER - AB E BACKFILL SEPTIC TANKS❑
DESCRIBED RESI AL PROP SEEP.PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTE
®f C.-
ALIDATION ROBERT A.WOOD
Y.O. CASH SUPERVISING MECHANICAL ENGINEER
EBD
7 6 A Ef `_D", APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS G�,/U/ NBSi
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 7-0Al i-'C Ctt
APPLICANT TO FILL IN NEAREST CROSS
CROSS ST, LkC F 4 Z✓S
(PRINT ORAYPE; ONLY)
LEGAL
DESCRIPTION LOT NO. / OWNER FLU 0 C�{in
MAIL }'
BLOCK TRACT t +' ADDRESSI
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF ZL.1 DISTRICT NO GROUP .LASS MAP pR OCESS E
BUILDINGS �• r,, 8N pG
CONTRACTOR 12, VJ, 'b►�G.�c �1n.r. ♦t� EC•.v',L7 i'j / 6
ADDRESS /041:L/� C-K(t.Q S s401L CON FEICTIONi DATA
CITY C+J►1 �'t T I G„ TEL. NO. 1112— STATION /J DEPTH 3
STATE LIC G/ UPPER
LICENSE NO, .Z��J.•-l� T CLASS G•{ MANHOLE REFERENCE `
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENG FROM
HOUSE SEWER CONNECTING TO i� Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER 0 .00
SEPTIC TANK.SEEPAGE PIT OR P.C.NO. 7/
PITS AND/OR DRAINFIELD a $10.00 CO.IMP. NO. �'
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. r
PRIVATE DISPOSAL SYSTEM $3.00 0-
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAlv[[ [�5[Mj Xi RECORD. INSTR.NO DATE O
WORK TO HOUSE SEWER $3.00 ]� �7 V
OVERFLOW SEEPAGE PIT.DRAINFIELD /� ( /
EXTN.,CESSPOOL.DRYWELL.M ANHOLE @ f5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING O
SEWER OR DISPOSAL SYSTEM (it $3.00 STATE ENCROACHMENT (J
PERMIT NO. LLI
d
INDUSTRIAL [n
WASTE APPROVAL Z
CHARGES
OWNERS PERMIT s 00
�
CONNECTION CHARGE FEE� AUTHORIZATION TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEW R. APPROVALS DAT INSP GTO R'S SIGNATURE
SIGNED THIS DAY OF �[ 191Z
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL Cl DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL
7L PROPERTY. ABANDON HOUSE SEWER:
ISI SIGNATURE `til 4L <..w, ,47 ��
SEEP, (SE) CESSPOOLS
CESSPOOLS,
OF PERMTTTEE_� +J
IDATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK. �.1�0. CASH