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Home My Public Portal About4919 GOLDEN WEST AVE_Sewer__ cx&GR zsk = - APPLICATION FOR PERMIT �GA641P ap COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL u DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSIQN BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKIN$. SUPT. OF BUILDING LOCA L I FY N EAR EST FOR APPLICANT TO FILL IN CROif R. Dp CRIPTION LOT NO. OWNER MAILrBLOCK TRAGI ADDRW NO. OF ■LOOS. BIZ[ OF LOT NOW ON LOT CITY TEL. NO. USK OF DISTRIcrJl O. GROUP MAt PRoc[�StD SY BUILDING■ /,•y ■K QQrG CONTRACT?ij� (�� O• _ UO ADDRWaj� jCON2(ECTION DATA CITY TIL. NO. � STATION DEPTH STATE 'LIC MANHOLE RCF[11ENCE LICK N RR NOI l`LA. " LOWER No. .DESCRIPTION OF WOFJK FEN TYPE OF CpNN[CTIOH LENGTH Fltpm HOUSE BE [R CONNECTING[CTING TO Y. GUYS P.L Y.L.TO If PUBLIC SEWER 45.00 SEPTIC ANI(.■ CPAG[PIT OR JO NO. O Prn ANb�OR DRAINFICLD 510.00 CO.IME.NO. JOS J10. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. p( PRIVATE DISPOSAL SYSTEM 49.00 CONNECT ADDITIONAL BLDG.OR APPIDAVIT FAME uu D1EET S RECORD.INTR.NO. ¢ATF O 0 WORK TO HOUR[SEWER $3.60 OVCRFLOW SEEPAGE PIT.DRAINFI[LI} [)[TN..CYISPOOL.DRYWELOMANHOLE 0 $5.00 H HOUSE HWY.OR ST.-WIDENING d[W[R flkMfr�ML SYSTEM 46 49.00 STAT[EIICROACHMENT Z PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWN ES'S PERM T i 2 00 CONNECTION CHARGE PEI A.oW0,NLATION TOTAL FF.E I HAVE AT THI■ DAT[ A CONTRACT WITH THE HEREIN NAMED N CON- IIKIMBURS[M[ T FEE T]tACTOR TO CONNECT THE ABOVE DESCRIBED E)Ii STING DWR.LING TO THE PUBLIC S R. APftOVAM DAT[ INSPECTOR'S N RE SIGNED THIS F .11110 L 1 OWNER OR NEW HOUSE YEWER OWNERS AG[ Cb NN[CT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) I HKRKPq ACKN?WL[OGE THAT I Hkft READ THIS APPLICATION A ND/OR DRAINFIELD AND STATE THAT THEABOVE IS CORRECT AND AGR[[ TO COMPLY WITH ALL COUNTY 0RDINANCKS AND STATE LAWS REGULATING PLUMBING AND SEWLRV. CKSSPOOL ❑ DRYWELL ❑ { I H[R[5Y CERTIFY THAT IL A4 PROPERLY REGISTERED AND/OR ALTER REPAIR.SEWER Qlt LICENSED Al REQUIRED ■Y LOS ANG4p COUNTY AND STATE OF S[WAGI DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RAID[ IN, THE ASO D[SCRIS RpIDEIITIAL OP[RTY t' ABANDON HOGS[SEWN SIGNATURE OF PER MtIT'[E BACK LL SEPTIC TANKS ❑ PEEP.FIPrr(S) cEfsrooLs �YALIDATION JACK R. ALLEN SUPERVI-SING MECHANICAL ENGINEER CK. Y.O. CASH LAC05 .L 21 0 ® 5,00- q • Y .n ' T124PLE CITY CK goo reta D r' TeAB4ED _APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION . F—=lt l N (}Olden West JOHN A. LAMBIE, Cou NTY ENGIN[[R COLEMAN W. JENKINS. SUPT. OF BUILDING Tomple City FOE APPLICANT TO FII.I, IN • Hallwood Dr. LKOAL DESCRIPTION LOT NO. OWNER Milton Bade MAIL BLOCK TRACT ADDRW 20 Bircharaft NO. OF SLDOB. SIZE OF LOT HOW ON LOT crnA i jq TEL. NO. US[ OF ■UILDINOS licks DISTRICT NO. GROUP MAT tY CONTRACTOR d g -1 .� ro ADDRW2Xaxson Rd. CONNECTION DAlA STATION/SI..��/� D[FTH CITY TIL. NO. G� J' STAT= LIC LIC[NS[ H G1.A'BB C J J No. I DESCRIPTION OF WORK FE[ TYPE OF CONNECTS P.L P, ,OM FOM' HOUSE SEWER CONNECT NO TO Y. CURB M. TO P.L PUBLIC*IrWER S5.00 SEPTIC TANKS RG[PIT OR P-C.NO- O PITS AND/OR DAINFIELD 510.00 CO.IMP.NO. —1-0_B HO, v HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. pC PRIVATE DISPOSAL SYSTEM Sa.00 CONNECT ADDITIONAL■ O.OR AFFIDAVIT EAA[E WINS".RECORD.INS .NO. DATE 0 0 WORK TO HOUSE SEWER [5.00 OVERFLOW SQPAO[PIT.DRAINFI<LD EXTN..C[BSPOOLDRYW[LL.MA NH OLE* [11.00 a ALTER.R PAIR O A S N ON OUSE HWY.OR T.WIDENING Z SEWER OR DISPOSAL SYSTEM 41 53.00 STATE ENCROACHMENT — PERMIT NO. INDUSTRIAL WASTE.APPROVAL OWNF.R"3 PERMIT s s 00 CHARO[S CONNECTION CHARD[FEE AUTHOHTLATION TOTAL FEE00 I HAVE AT THIS DATE A CONTRACT WITH TMX HEREIN NAMED CON- REIMSUR"M[M FEE TRACTOR TO CONNECT THE ABOVE-DESCRIBED EAIeTINO DWELLING TO THE PUBLIC SEWER. APPROVALS DATE I N SP[CTO R'S 010 MATU R[ SIGNED THIS DAY OF iQ_ y OWNER OR HEW HOUSE SiW[R -6♦ OWNERS AGENT CONNECT ADDITIONAL ADDRESS SUILDINO OR WORK SEPTIC TANK,BEST,PIT(6) I HEREBY ACKNOWLeDGE THAT I HAVE Fit— THIS APPLICATION AND STAT[ THAT THE AMQVE IS CORRECT AND AOR[[ TO COMPLY AND/OR DRAINFI[LD WITH ALL COUNTY 0ROMANCES AND STATE LAWS REGULATING CL/ePOOL El DRYWIll [IPL UMI, ING AND SEWERS. I RER[SY CERTIFY THAT I A4 PROPERLY REOISTERED AHD/OR ALTER,REPAIR,SEWKM OR E - LICENSED AS REQUIRD SY LOS VW AOCOUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM r CALIFORNIA OR THAT I AM THE LEGAL OWNER AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ASOV[ DESCRIBED RESIDENT[ PR ABANDON HOUSE SEWER SIGNATUREPXRMTTT[E OF FP[ AACKFILL S[ IC TANKS ❑ '[[P,PIT(S) U CESSPOOLS G M.O. CATH AIMATION JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER 4 �6 2 7 1�8 SEP - 5 1 0 0 5�70N DEPAKTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING - - ADDRESS FOR APPLIC NT TO FILL IN LOCALITY BUILDSNG �j /� NEAREST ADDRESS 4"'r'J�y �j?�jt/ �/ � CROSS ST. LOCALITY_I� le- DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A S CROSS ST. RECEIVED BY Ready for Inspection DATE[SSUED OWNER r_ MAIL ADDRESS �J�/ E.' �t USEZONE OCCUPANCY MAP BK PG CITY TEL.NO. CONTRACTOR CO.IMP.NO. ADDRESSSO, %rte r - JOB NO. CIT EL.NO. „Y TRUNK PERMIT N0. STATE REGISTRATION NO. COUNTY ROAD PERMIT N0. 23�c�� LEGAL i DESCRIPTION LOT NOdil STATE ENCROACHMENT PERMIT NO. BLOCK TRWAET � INDUSTRIAL WASTE APPROVAL SIZE OF LOT roX NO.OF BLDG& NOW ON LOT CHARGES USE OF BUILDINGS CEJ/ �°'/�(J�,J CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLICSEW_ER Q $ 3.50 RECEIPT NO. I DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM I.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. DATE I 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 0f3 DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE, UPPER LOWER TYPEOF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y. CURB ---P.L. - M.L.TO P.L. AUTHORIZATION I TOTAL FEE I 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 SIGNEDTHIS__ DAY OF. ..............................19� NEW HOUSE '. CONNECT ADDITIONAL A OWNER OR [x OWNERS AGENT..........C., ----------------------------------•-------- BUILDING OR WORK ADDRESS............ .f SEPTIC TANK,SEEP.PIT(S) f ........ ......--•---- AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] 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 OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DE CRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURESEEP.PIT(S)0 CESSPOOLS OF PE RMITTEE.-.__ .el� _:�2 --./,'t-' 76A642D 663 1/53 '��/1;