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HomeMy Public PortalAbout5337 GOLDEN WEST AVE_Sewer__ 78A84IY�D' APPLICATION FORPERMIT 7GA64. COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBTE, County Engineer ADDRESS CASSAIT D.'GRIFFIN, Supt of Building LOCALITY NEAREST FOR APPIWAA'NT T�O/�FILL IN CRO ss ST. /(� -DESCRIPTION LOT NO.S ��/' /V Lb�/ pp OWNER �' {f ✓ P BLOCK TRACT/4,- MAIL � A /,tea//d C '✓ r ADDRESS N0.OF BL SIZE OF LOT Z�p` NOW ON LOT CITY TEL. N0. USE OF BUILDING DISTRI�. GROUP BK MAP PG OCESSED Y- CONTRACTOR 7 ADDRESS 8j�i�� vac 1/) CONNECTION DATA CITY TEL. NO. a Z- TION DEPTH 'L TATE ANHOLE REFERENCE PEIZ vam REGISTRATION N0. I COUNTY NO. DESCRIPTIO OF WORK - FEE - - `� HOUSE SEWER CONNECTING TO trevi PUBLIC SEWER $8.00 �6 TYPE OF CONNECTION LENGTH FROM PETS ANTIC D%OR DRAINFGIELD T OR $8 OO Y. CURB P.L.- M.L.TO P.L. j OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN ,CESSPOOL,DRY-WELL,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 NO. WORK TO HOUSE SEWER @ $1.00 SEWER'OR DISPOSAL SYSTEM HOUSE @ $1 00 VINDUSTRIAL OACHMENT OVAL CHARGES OWNEWS PERMIT t 2 X'00I CHARGE FEE AUTHORIZATION TOTAL FEE F✓ IMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONAPPROVALS DATE INSPEC pR:S IGN TURF TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLINL rA TO THE PUBLIC SEWER. - SIGNED THIS DAY OF 19_ W HOUSE SEWER L OWNER OR / NNECT ADDITIONAL OWNERS AGENT /,! ILDING OR WORK PTIC TANK,SEEP;PITS) ADDRESS D/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIOAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLSSPOOL❑ DRYWELLWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINTER, REPAIR,SEWER OR PLUMBING AND SEWERS. WAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OSCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OANDON HOUSE SEWER CALIFORNIA OR THAT I AM T E LEGAL OWNER OF THE ABOVDESCRIBED RESIDpNf1 ROP TY. BACKFILL SEPTIC CESSPOOLS SIGNATURE � OF PERMITTE ®� ILP VALMATIO( ROBERT A.WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER !16904 t4INY221 0- A - � 76A842D CF80es-se - APPLICATION FOR PERMIT 1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS J 3 CK CASSATT D. GBDTM, Supt of Building LOCALITY C FOR APPLICANT TOOwl" FILL IN ceoss sr. LEGAL DESCRIPTION LOT NO /7 OWNER' ( Ve BLOCK TRACT lJS D�+ v�{�u�/EJt ✓�� MAIL ADDRESS_, S �ZIp ��NO.OF BLDGS. SIZE OF LOT - NOW ON LOT CITY TEL.NO USE OF / BUILDINGS! p� DISTRI�O. GROUP MAPROCESS D BY BK P6 � CONTRACT O `.� G y v �` ADDRESS /H CONNECTION DATA CITY �Yi ��G TEL. 40. Q/2 L TI l DEPTH REGISTRATION NO. U-74 Z— COUNTY" MANHOLE REFERENC PPER Lq 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 Q $8.00 URB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT, DRAINFIELD G EXTN.,CESSPOOL,DRY-WELL,MAN HOLE 0 $2.00 HOUSE SEWER CONNECTING TO ?' © Com— P.C. NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. J �v+ JOB NO. CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT NO. ROAD PERMIT N0. WORK TO HOUSE SEWER a $1.00 SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT PERMIT N0. ' INDUSTRIAL WASTE APPROVAL 8 CHARGES O, 'S' PERMIT $ CONNECTION CHARGE FEE AUTHO ATION TOTAL FEE REIMBURSEMENT FEE 1 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 SAY OF i 9_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL _ OWNERS AGENT BUILDING OR WORK 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 REQUIR BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA ORT AM THEERWNER OF THE ABOVE BACKFILL SEPTIC TANKS C]RE DESCRIBED SID PROPE EP. PIT(S) ❑ CE DOLS SIGNATURE OF PERMITTE 1 ®P VALIDATIO ROBERT A.WOOD Ca. N.o. CAs SUPERVISING MECHANICAL ENGINEER cab 6 �-Ot56; MAY 22 1 1' H 2 5.0 0 , 1