The URL can be used to link to this page

Home My Public Portal About5806 GOLDEN WEST AVE_Sewer__ 76A842DAPPLICATION FOR PERMIT ceeoe e•ae COUNTY OF LOS ANGELES ( Z SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGMEER / / BUILDING AND SAFETY DMSION ADDREISS SJ O CO CrZ) C/�e ale S O A LAMBIE, County E�qi�eer C D. GRIFFIN, Supt o[Building LOCALITY L/ NEAREST F APPLICANT TO FILL IN CROSS ST LEGAL OWNER /L V- LC DESCRIPTION LOT N0. � t� y BLOCK TRACT J! MAIL / /p - �/ ADDRESS [) ]'� p tp w SIZE OF LOT V/� �Y C`J NOW ON LOTS � CITY 0- V 6` TEL NO C O USE OF BUILDINGS o rweG Q ala. 1' DISTRICT N0. GROUP MAP { PROCESSED BY BE: PG I CONTRACTOR41 � Ir 0� ADDRESS S' CONNECTION DATA CITY TEL N0. STATION DEPTH STATE REGISTRATION N0. COUNTY MANHOLE REFERENCE_+01 (S,92p_ ' U LOWER NO. I DESCRIPTION OF WORK FEE ` HOUSE SEWER CONNECTING TO 6y V . PUBLIC SEWER C6 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P L. M.L.TO P.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. o JOB NO. CONNECT ADDITIONAL BLDG OR1RUNK PERMIT NO. ROAD PERMIT NO. 9 WORK TO HOUSE SEWER $I 00 ' ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEW ER'OR DISPO L SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL - WASTE APPROVAL CHARGES OWNER'S PERMIT S 21 00 CONNECTION CHARGE FEE A=ORNATION I TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CO NECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE 1 TO THE PUBLIC EWER. / // SIGNED THIS DAY OF 9I'2_ /�� /NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT - BUILDING OR WORK f'ADDRESS �6 / - ro �_ EPTIC TANK,SEEP.PIT(S) •'AND/OR DRAINFIELD I HEREBY ACKNOWLEDG THAT I HAVE READ THIS A LICATION 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ROVE DESCRIBED BESA PROPERTY. BACKFILL SEPTIC TANKS ❑ L' y r�/_ ��5 SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS OF PERMITTE fX\i - - ®r VALIDATION ROBERT A. WOOD OIL M.o. CASH SUPERVISING MECHANICAL ENGINEER f0-63 76A642D APPLICATION FOR PERMIT 8A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDI7NG JOHN A. LAMBIE, County Engineer ADDREWILLIAM A. JENSEN, Sup't of Building LOCALINEAREFOR APPLICANT O FILL IN CROSB LEGAL DESCRIPTION LOT NO Z OWNER _ MAIL BLOCK TRACT S ADDRESS NO OF BLDGS SIZE OF LOT _ X I NOLf W ON L CITY TEL NO USE OF BUILDINGS DISTRICT NGROUP MAP PR O ED BY r` J BK PG CONTRALTO ADDRESS_ >j ( l I COG•NNECTION DATA CITY TEL NO 40 6 S'9ATION DEPTH ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO ❑ COUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L L �- PUBLIC SEWER @ $5 000- SEPTIC TANK,SEEPAGE PIT OR CO IMP NO JOB NO O PITS AND/OR DRAINFIELD @ 31000 U HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO p[ PRIVATE DISPOSAL SYSTEM S300 ^ CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER CAS[MINT RECORD INSTR NO DATE 0 / WORK TO HOUSE SEWER @ $300 `^ V OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN CESSPOOL,DRYWELL MANHOLE @ $500 0- ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING H SEWER OR DISPOSAL SYSTEM @ S300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 AUTHORIZATION TOTAL FEE �U CONNECTION CHARGE FEE CHARGES 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TOCONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS _ Y OF 19_ OWNER OR ♦ NEW HOUSE SEWER OWNERS AG T p CONNECT ADDITIONAL �(� ADDRESSBUILDING OR WORK �•�j �r • SEPTIC TANK SEEP PIT(S) ( r U 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION qND/OR DRAT NFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO DESCR ED RESIDENTIAL PROPER T ♦ ABANDON HOUSE SEWER A i SIGNATURE � . OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP PIT(S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER LjkGo 2 3 6 3 ZZ AUG 7 1 0 0 5.00- V