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Home My Public Portal About5339 GOLDEN WEST AVE_Sewer__ 24650 INSERTS, .YCE8088.80 _ �_--�Y Y �IrV• ��Vt.v• *FOR PE.RM1 �`r'.• i. 1,76A842D ' COUNTY OF LOS ANGELES ., SE —SEUV/4C,aE DISPOSAL, DEPARTMENT OF-COUNTY ENGINEER BUILDING AND SAFETY-DIVISION BUILDING ADDRESS JOHN A.'LAMBIE, County Engin or f WILLIAM A. JENSEN, Sup't of Building 'LOCALITY NEAREST ` FOR APPLICANT TO FILL IN 5�j CROSS ST. LEGALq D - / 1 • - -�' r . DESCRIPTION LOT NOAS' W$� 'OWNER e-'W' BLOCK TRACTM MAIL S -d 1,P(,.W c. ADDRESS. - 5 NO OF BLDGS. ' SIZE OF-LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR I ,_ ;3 ADDRESS CONNECTION DATA - - CITY TEL NO. .. f -� STATION PTH STATE ' MANHOLEREFERENCE _1 REGISTRATION NO L L O _ ( COUNTY LOWER NO I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 00 TY OF CO LENGTH PLD SEPTIC TANK,SEEPAGE PIT OR Y. P.L. M.L.TO .L. PITS AND/OR DRAINFIELD @ $3 00 , OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN- CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO P.C.NO. , PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP 'N0. JOB NO. CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $1 00 ,TRUNK PERMIT N0, ROAD PERMIT NO., O U 'ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT Pb SEWER ORDISPOSAL SYSTEM @ $1 00 PERMIT NO - p �' -INDUSTRIAL F , WASTE APPROVAL _ W CHARGES N ' OVMER'S PERMIT g CONNECTION CHARGE FEE 4, AUTHORIZATION I TOTAL FEE ! REIMBURSEMENT FEE ~ I HAVE AT THIS DATE 'A CONTRACT WITH THE HEREIN'NAMED CON- _ _ -_ _' TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING ,DWELLING APPROVALS ,PATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY SOF 19_ NEW HOUSE SEWER- OWNER OR - !AJ ^ CONNECT ADDITIONAL , OWNERS AGENT /// BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PITS) AND/OR DRAINFIELD. ICO 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 PLUMBINGAND 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 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED OR TIA PROPERTY. r BACKFILL SEPTIC TANKS ❑ y • - SIGNATURE SEEP. PIT(S) CESSP OLS ` OF PERMITTE OIng F VALIDATION ROBERT A. WOOD ` CK H.0• CASH SUPERVISING MEC HANICAL_ENGINEER 2--5.00- 24650 INSERTS •CEAO642D tl - APLIVATI'V�A 0 OR PERMIT 7fiA8 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL , DEPARTMENT OF COUNTY ENGINEER ) BUILDING AND SAFETY DIVISION BUILDING EPIROCESSED ADDRESSJOHN A. LAMBIE, County Engineer WILLIAMA. JENSEN, Supt of Building LOCALITYNEAREST �FOR APPLICANT TO FILL IN cRoss sr.LEGALDESCRIPTION LOT NO � o W PS p OWNERAl MAILBLOCK TRACT M SS O N /�e W 'ADDRESSNO OF BLDGSSIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS TDISTRICT N0. GROUP MAP BY BK PG CONTRACTOR SQ ! L ADDRESS 3 CONNECTION DATA - CITY TEL 6J TIONS DEPTH QS' 57 `� STATE MANHOLE EFERENCE REGISTRATION NO. IG 0 ` !� COUNTY kLOWER NO. DESCRIPT ON OF WORK FEE HOUSE SEWER CONNECTING TO 1 1 0 PUBLIC SEWER @ $ 00 TYPE OF ONNECT LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR VTRUNK CU B P.L. M.L.TO P.L. 1 PITS AND/OR DRAINFIELD @ s 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL@ $ 00 HOUSE SEWER CONNECTING TO P.C NO. PRIVATE DISPOSAL SYSTEM @ $ 00 . JOB NO. CONNECT ADDITIONAL BLDG.OR IT NO. ROAD PERMIT NO. UWORK TO HOUSE SEWER @ $1 00 SEWE R�OR PAIRO R A SYSTEM HOUSE @ $1 00 OACHMENT F ,INDUSTRIAL CZ WASTE APPROVAL kwat CHARGES U2 OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ,DATE* INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DArY� OF 19-- NEW HOUSE SEWER 10:� OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE*THAT I HAVE READ THIS.APPLICATION - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ElLL DRYWE •❑ ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF -ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 M THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT AL OPERTY. BACKFILL SEPTIC TANKS ❑ SEEP.PIT(S) ❑ CE LS. _ SIGNATURE OF PERMIT TE OF : / ALIDATION ROBERT A. WOOD K./AY m.o. H SUPERVISING MECHANICAL ENGINEER ,_ -fit 76A6423-61 APPLICATION FOR P MIT 76A 642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A, LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY12 NEAREST FOR APPLICANT TO FML IN CROSS ST. LEGALI OWNER DESCRIPTION LOT N0. YC{s� BLOCK TRACT rJ yGL IL !d DRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITU' TEL. NO USE OF BUILDINGS DISTRICT NO. GROUP K PO HAP PROCESSED BY r B CONTRALTO VaS 0 (/ �+ 3 c a u-ro ADDRESS A CONNECTION DATA CITY TEL.NO �j -10. STATION 2 0/ DEPTH 'N STATE REGISTRATION NO. ` COUNTY MANHOLE REFERENCE UPPER LOWER No. I DESCRIPTION OF WORK FEE _ OUSE SEWER CONNECTING TO Q, S✓ PUBLIC SEWER TYPE OF CONNECTION LENGTH FROM -f; SEPTIC TgNK,SEEPAGE PIT OR Y. CURB P.L H.L.TO P. (�U PITS AND/OR DRAINFIELD @ S8.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN CESSPOOL DRYWELL @ $ 2.00 HOUSE SEWER CONNECTING TO CO IMP. N . C, JOB NO. (t1�h_ ( PRIVATE DISPOSAL SYSTEM @ $1.00 CONNECT ADDITIONAL BLDG.OR 3 �� TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER 31 00 ALTER,REPAIR OSAABANDON HOUSE @ $1 00 STATE ENCROACHMENT O PERMIT N0. V W INDUSTRIAL a WASTE APPROVAL cn ��rw�+p CHARGES Z � �Va�EWS PERMIT $ 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 19 REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA ED CON. 67- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGp4TURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19- NEW HOUSE SEWER A OWNER OR CONNECT ADDITIONAL gdoL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/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 pLTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES C UNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM E LEGZT OF THE ABOVE BACKFILL SEPTIC TANKS ❑ DESCRIBED RESID IAL PRO TY. SEEP.PIT(S) CESSPOOLS SIGNATURE 'll OF PERMITT iL ,.,�IROBERT A. WOOD cd/J r..0.o. cAex SUPERVISING MECHANICAL ENGINEER ;09 6 1 6 MAR 1 5 1 0 D 5 .Q G r