The URL can be used to link to this page

Home My Public Portal About5733 GOLDEN WEST AVE_Sewer__ 0-63 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DIS SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building LO CAL,TY NEAREST FOR APPLI NT TO FILL IN CROSS ST LEGAL DESCRIPTfON LOT N 90, D q OWNER / MAIL BLOCK TRACT ADDRESS, y SIZE OF LOT NOWOON LOTS CITY ((� t_ I TEL NO USE OF _ DISTRICT NO GROU MAP PROCESSED BY BUILDINGS � SK PG CONTRACTOR Q ADDRESS CONNECTION DATA STATION DEPTH CITY TEL NO STATE UPPER REGISTRATION NO COUNTY MANHOLE REFERENCE LOWER NO GES CRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL M L TO P L PUBLIC SEWER @ $5 00 a, SEPTIC TANK,SEEPAGE PIT OR P C NO .108 NO PITS AND�OR DRAINFIELD @ $1000 CO IMP NO O V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 O CONNECT ADDITIONAL ' �p.,�� AFFIDAVIT I wAIYrN EASeMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER $3 00 !J V OVERFLOW SEEPAGE PIT DRAINFIELD EXTN,CESSPOOL,DRYWELL MANHOLE @ $5 00 a HWY OR ST WIDENING ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL I t OWNERS PERMIT $ 2 00 CHARGES AUTHORIZATION TOTAL FEE � CONNECTION CHARGE FEE I HAVEAT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER g _ OWNERS AGENT 2 CONNECT ADDITIONAL WH ADDRESS G O R W O R K e SANA SEEP PIT(S) E I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/ORND/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 ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO D15CONN ECT PLUG AND RESIDE IN THE AAE DESCRIBED RESIDENTIAL PROPERTY gBAN DON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ElOF PERMITTEE - SEEP,PITS) CESSPOOLS ❑ VALIDATIOnAS ROBERT A. WOOD CK M O UPERVISING MECHANICAL ENGINEER LAUo 2 8 9 51 JM 21 1 0 D 5.0 0- 1z DEPART3M';T OF COUNTY ENGINEER SEXIER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING )7, ADDRESS 7jj3 /J FOR APPLICANT FILL IISTUATTCY LOCALITY BUILDING ; NEAREST n/► L v ADDRES r CROSS ST. 1 V LOCALITY QDISTRICT NO SERIAL NO. 0 PERMIT NO. C NEAREST S CROSS ST. R EIV D BY ,Ready for Inspection ATE ISSUED OWNER MAIL / /J USE ZONE OCCUPANCY B g ADDRESS / CITY TELNO. ��/ I t< CONTRACTOR / CO.IMP.NO. ADDRESS: �'- JOB.N0. CITY�� l" TELAO. TRUNK PERMIT NO. —1 STATE REGISTRATION N0. ROAD PERMIT NO. a 76 df-6/ LEGAL a STATE ENCROACHMENT- DESCRIPTION LOT N0. S G v PERMIT NO. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT_3_0 X N0.OF BLDGS. e CHARGES HOW ON LOT USE OF CONNECTION CHARG EE BUILDINGS % %Y/'� f NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO — PUBLIC SEWER Q ; 3.50 .J S75 RECEIPT NO. I DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTIOORECORDED WORK TO HOUSE SEWER 1.00 N0. ( 1 PATE BY ALTER OR REPAIR EXISTING 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/ORDRAINFIELD 2.00 STATION ,3 DEPTH e.2- CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 � 9D 1i1 MANHOLE REFERENCE LOWER TYPE OP 60NNECTION LENGTH FROM �� CURB �Bj_ M.L TO P.L. OWNERS PERMIT ; 1 00 AUTHORIZATION TOTAL FEE 1 1 HAVE THIS DATE CONTRAOTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR' IONATURE DATE DWELLING TO THE PUBLIC SEWF,g-- SIGNED THIS... DA7 OF d�L �� „1�'� NEW HOUSE SEWER dy i CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGEN1__. r f� _ l� / SEPTIC TANK,SEEP.PIT(S) ADDRESB.�. _ _. ._ .__ -L.�. ...._�._.-.__.� AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL 0 DRYWELL El CA TIONAND 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 1 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 TH I AM THE LEGAL OWN- ER OF THE ABOV5,Z!!�SCRIBEI)OfMIDENrl. PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S)[j L'CESSPOO OF PERMITTEE !',. __ �� .......... _....... 76A642A 663 7/53 r��jy✓�