HomeMy Public PortalAbout5912-5916 GOLDEN WEST AVE_Sewer__ 76AS42D , .f•�
S E•66311-55 APPLICATION. FOR PERMIT �-
DYVISION OF BUILDING AND SAFETY SEWER-S E WAGE DISPOSAL
Department of County Engineer-
,County Of LOS Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS c
® CASSAT.T D GRIFFIN, SUP'7 OF BUILDING LOCALITY r
^ / d /
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
DESCRIPTION LOT LEGALOWNER
s� f MAIL
BLOCK- TRACT ADDRESS
NO.OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF DISTRICT Nggq.
BUILDINGS GROUP MAP I BK P /
CONTRALTO
ADDRESS
CONNECTION DATA
�
CITY TEL N . /7 ON G�A Q DEPTH '
�/� d'� [•� WHOLE REFERENCE.99 ,1 -3 PPER
,�•s�1
REGISTRATION N01 �9J �❑ COUNTY r
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 50 Y' �pT� M L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO. V I -
EXTN ,CESSPOOL,DRYWELL,MANHOLE cQ $2 00 CO IMP NO. !OB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
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 @ $100 WASTE APPROVAL
CHARGES
O CONNECTION CHARGE FEE
OWNER'S PERMIT $
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED co N- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING TWELLING '
TO THE PUBLIC SEWER. NEW HOUSE SEWER -
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK, -
OWNERS AGENT SEPTIC TANK,SEEP, PITS)
ADDRESS AND/OR DRAINFIELD
I 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
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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE l S P PIT(S) ❑ CESSPOOL
OF PERMITTEE / _�j
(� -/-S7
JOHN A LAMBIE, COUNTY INEER VALIDATION ROBERT A WOOD. CHIEF PLBG INSPECTOR
CK. N 0 CASH
ACO
3'0 6 1OCT 7 5 2 5.0 C7 6
7&FE-663 11.95
8 APPLICATION FOR PERMIT
8 -86 •
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
_
Deportment of County Engineer
County of Los Angeles BUILDING d
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® _ CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITYNEAREST
FOR APPLICANT TO FILL IN CROSS ST. ,[/J r�/ / ¢Sdo¢✓/Jo_ ;
LEGAL OWNER
DESCRIPTION LOT NO (.�'d MAIL
BLOCK
BLOCK TRACT - ADDRESS
NO. OF BLDGS. CITY TEL. NO.
'
SIZE OF LOT NOW ON LOT
USE OF
DISTRICT NO.- _ GROUP MAP
BUILDINGS f BK PG
CONTRACTOR S .r '
ADDRESS CONNECTION DATA
-CITY TEL ION DEPTH
NHOLE REFERENCE / UPPER ,
_ 1'❑ STATE
REGISTRATION N0, ❑ COUNTY _
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM /
PUBLIC SEWER @ $3 50 _wp M.L TO P,L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGEPIT, DRAINFIELD P. C. NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $ 2 00 CO IMP. NO. JOB NO.
' HOUSE SEWER CONNECTING TO _
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
F115 4�
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT-
WORK TO HOUSE SEWER @ $1 00 'PERMIT NO _
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL '
CHARGES
CONNECTION CHARGE FEE _
OWNERS PERMIT $ 1 00 /
r, REIMBURSEMENT FEE `�� � ,1 ,�� /� vi��� "
AUTHORIZATION .TOTAL FEE v�"c,� K U.'1 W�
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON• APPROVALS - DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLI NEW HOUSE SEWER
SIGNED THI� OF 19 CONNECT ADDITIONAL
OWNER OR - BUILDING OR WORK '
OWNERS AGENT '
SEPTIC TANK,SEEP„PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[__1AND 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT ABANDON HO PLUG PLUGUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF -THE ABOVE
ER
DESCRIBED RESIDENTIAL PROPERTYBACKFILL SEPTIC TANKS❑
SIGNATURE SE P PIT(S) LlCESSPOOLS❑
OF PERMITTEE O _ /Q
JOHN A. LAMBIE, COUNT GINEER V; LIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
b O CASH
3O6fl- PU , .7 4 4.5G M.