HomeMy Public PortalAbout5743 GOLDEN WEST AVE_Sewer__ �n r
CE808 D 8-89 APPLICATI N FOR ERMIT
E808
COUNTY OF LOS ANGELES SE ER-SEWAGE DISPOSAL
DEPARTMENT ,OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS '7`'
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Suildiag LOCALITY
NEAREST
FOR APPLICANT TO FILL CROSS ST.
LEGAL ` OWNE
DESCRIPTION LOT N0.
�^ MAIL
ADDRESS
BLOCK TRACT Q
N0.OF BLDGS. 3
SIZE,OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS STRBK I
CONTRACTOR K— P6
ADDRESS r ' CONNECTION ATA
CITY TEL.N0. STATION DEPTH
{{ ❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. 4� zz ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE %
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OFCO NEC ION LENGTH FROM
ITS AND/ORSEPTIC TANK'DRAEINFSEPAGEEL IT OR @ $3.00 Y. C B P.L.
M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD f
EXTN..CESSPOOL.DRYWELL @ S2.00
HOUSE SEWER CONNECTING TO P.t.NO. .
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. 1 JOB NO.
CONECWORK TOTHOUSEDDITIONAL SEWERBLDG.OR @ $1 00 �•• TRUNK PERMIT N0. ROAD IT NO.
✓ ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE i
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NN ED CO - `
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE C
SIGNED THIS D Y F 19 NEW HOUSE SEWEROWNER
OWNERS AGENT "�! '� "�/a BUILDING ONECT R
WORKZ
ADDRESS (.�. SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I- HEREBY ACKNOWLEDGE THAT 1HAVE 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 1 AM PROPERLY REGISTERED AND DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THFy AB E
DESCRIBED RESIDENTIA * PPE Y. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTE
OF" VALIDATIOASH ROBERT A. WOOD
!b
CK. M.D. \ CASH"/ SUPERVISING MECHANICAL ENGINEER
DEC 5 1 0 0 3.0 0
E-6D
S E•863 11.68
APPLICATION FOR PERMIT
3&
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department t of County Engineer yat t��y
County Of LOSL
l@3 ADDRESSG JOHN A. LAMBIE, COENGINEERCASSATT D. GRIFFIN, SF BUILDING LOCALITY
FO A PLICANT TO FILL IN CROSS T.
LEGALDESCRIP 0 LOT Ny OWNER
MAIL
BLOCK TRAC' /�G � ADDRESS S7 V
NO. OF BLDGS. CITY A s� TEL. N0. e'
SIZE OF LOT �,�'iv v NOW ON LOT /' ` ?R
USE OF
BUILDINGS DISTRICT GROUP MAP
- BK PG
CONTRACTOR lj�� /-D J/Z
ADDRESS ' i CONNECTION DATA
STATION DEPTH S
CITY T 1N ..i MANHOLE REFERENCE b�J
i ❑ STATE LOWER
REGISTRATION N . ❑ COUNTY
NO. DESCRIPTION OF WOFZK FEE TYPE OFC CTION LENGTH FROM `
HOUSE SEWER CONNECTING TO - Y. RB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD Q $3.00-
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO. IMP. NO. !�^�,�1 �, JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT N0. ROAD PERMIT NO. °L
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM a $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE � REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DACE INP- TOR SSIGNAT RE
x TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER'. NEW HOUSE SEWER
SIGNED THIS ' �-��4Y OF 'J 19� CONNECT ADDITIONAL i
_ OWNER OR ¢„lf� `hy,� !/ BUILDING OR WORK _ -
OWNERS AGENT
/� SEPTIC TANK,SEEP,PIT(S)
ADDRESS aS Y��g55 " ' 'f�� 6 1- � AND/OR DRAINFIELD -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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 UNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGA OWNER OF T/HE ABOVE
DESCRIBED RESIDENTIA OPE Y: / TIC TAN
SEEP.BACKFPIT(SILL EP❑ CESSP00❑LS
SIGNATURE -
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PLBG. INSPECTOR
CK. M.O. CAS