The URL can be used to link to this page

Home My Public Portal About5957 GOLDEN WEST AVE_Sewer__ L 10-63 76A642D APPLICATION OR PERMIT 6A64 �J 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 Buildmg LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS 5T LEGAL / DESCRIPTION LOT NO OWNER ` MAIL BLOCK TRACT " ADDRESS NO OF BIL GS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICTN GROUP MAP PROCESSED BY BK PG CONTRACTOR 11�4LZgNA � z ADDRESS f�, CONNECTI N DATA � CITY /� TEL NO /3 STATION DEPTH ccl STATE MANHOLE REFERENCE UPPER REGISTRATION NO COUNTY NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TOIL PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR PC NO O PITS AND/OR DRAINFIELD @ S1000 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT PRIVATE DISPOSAL SYSTEM @ $3 00 ^ CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIVEq EASEMENT RECORD I R NO DATE H WORK TO HOUSE SEWER @ $300 V OVERFLOW SEEPAGE PIT DRAINFIELD LLI EXTN CESSPOOL DRYWELL MANHOLE @ $500 At4$�R'ARC•P14FR-6A ABANDON HOUSE HWY OR ST WIDENING N SEWER OR, @ $300 _ STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPR AL OWNERS PERMIT S s 00 CHARGES AUTHORIZATION TOTAL FEE CONNE TION CHARGE FEE 1HAVE AT 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 OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTICTANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATfNG PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 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 IAM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND I �9, RESIDE IN THE ABOVE BED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER IU�W SIGNATURE `+ BACKFILL SEPTIC TANKS ❑ OF PERMITTE SEEP PITS) ❑ CESSPOOLS ❑ LIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH Lko5 5 7, 2 5-0-1- NOV 9 1 0 D 5.00- '6A64210 - ----.p►PPLICATIOIV FOR PERMIT - 1 s&E•663 11.53 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Dep. ent of County Engineer County of LOS Angeles BUILDING , JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY Temple cl_ty' FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO.'!& 59y/J"� OWNER �`OmIlIL1111ty, Methodist- (',hutch [S MAIL • eg Architect ec BLOCK TRACT L ADDRESS �L T --� t� �T'lVe N0. OF BLDGS. CITY TEL. NO •. SIZE OF LOT ry NOW ON LOT CITY asade ' USE OF C urcy, T DISTRICT NO; GROUP MAP BUILDINGS Church BK PG A -; �- CONTRACTOR' _ a er+ Plumbing m _��_�� CONNECTION DATA A°°REss�1�pE Huntington Dra- - - CITY Arcadia TEL'. NO. Do- 811E6 STATION DEPTH MANHOLE REFERENCEUPPER VESTATE REGISTRATION NO, 810 + ❑ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CTION LENGTH'FROM 'Y- UR P L. M.L.TO P.L. 1 PUBLIC SEWER @ $3.50 0 SEPTIC TANK,SEEPAGE PIT OR PITS AND/0_11 DRAINFIELD. 'Q $3 00 OVERFLOW SEEPAGE PIT,DRAINFIELD //�� P. C. NO. EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP. N0. 3(�� JOB NO.' 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 SYSTEMQ $1 00 WASTE APPROVAL CHARGES OWNERS PERMIT $ 1 00 CONNECTION-CHAR-GE FEE' -- Y AUTHORIZFiTION TOTAL FEE 0 REIMBURSEMENT FEE a I HAVE AT THIS DATE A CONTRACT-WITH THE HEREIN NAMED coN- APPROVALS DATE INSPECTOR*SSIGNATURE, TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO'THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS DAY OFl9�� CONNECT ADDITIONAL OWNER .OR /�/_ BUILDING OR WORK OWNERS,AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS �••, _ �w�� AND/OR DRAINFIELD - I HEREBY AC OWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE TI-eT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALLCOUNTY 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 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT' L' PROPERTY BACKFILL SEPTIC TANKS El SIGNATURE SEEP PIT(S) C1 CESSPOOLS El , OF PERMITTE - ' JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR CK b O CASH - - i.ACo 4 -2 0 9 E JAN 16 `4 4_5 0 .t In _ _ , ! E-6D S& 89 I1-93 - APPLICATION FOR PERMIT - 1 E•8 DMSION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L Deportment of County Engineer County of LOS Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS --.% ® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL,IN CROSS ST. LEGAL OWNER DESCRIPTION LOT NO MAIL BLOCK TRACT - ADDRESS i�Jt r _ J NO. OF BLDGS CITY TEL NO SIZE OF LOT NOW ON LOT USE OF DISTRICT NO. GROUP MAP BUILDINGS V �„o- K PG CONTRACTOR y CONNECTION DATA ADDRESS CIT TEL1412� . NO ``^^ � STATION I v 4B' DEPT IV - / MANHOLE REFERENCE UPPER s ❑ -STATE 70 REGISTRATION NO. , ❑ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OFC TION _ LENGTH FROM fj Y. RB P L. M L TO P.L. PUBLIC SEWER @ $ 3.50 � �4 SEPTIC TANK,SEEPAGE PIT OR - PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE PIT,DRAINFIELD P C. N0. EXTN ,CESSPOOL,DRYWELL,MAN HOLE Q $ 2 00 CO. IMP. NO, O JOB NO HOUSE PRIVATE DIGER CONNECTING TO DISPOSAL SYSTEMQ $1 00 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR /��/� STATE ENCROACHMENT WORK TO HOUSE SEWER Q $1 00 V V PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL ' SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL 'CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE rig- IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE _ INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER (✓IS�Wi' +�� SIGNED THIS�DAY OF 1 ONNECT ADDITIONAL OWNER _ BUILDING OR WORK OIYNERS N SEPTIC TANK,SEEP,PIT(S) ADD - tES 1 AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL 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 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT PROPERTY BACKFILL SEPTIC TANKS❑ / / / 0 SEEP PIT(S) ❑ CESSPOOLS -SO, "t� it - SIGNATURE , OF PERMITTEE JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT ;k WOOD, CHIEF PLBG. INSPECTOR CK. M 0. �G f 0-63 76A6420-63 APPLICATION FOR PER IT 6A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING re,- D JOHN A. LAMBIE, County Engineer ADDRESS 6-G e� Q S WILLIAM A. JENSEN, Sup't of Building LOCALITY e f..-L. `p NEAREST FOR APPLICANT TO FILL CROSS ST C o ' LEGAL DESCRIPTION LOT NO OWNER `�i V'C �, / MAIL BLOCK TRACT ( ADDRESS NO OF BLDGS 1 SIZE OF LOT NOW ON LOT CITY TEL NO USE )F BUILDINGS �^ U/i—G 1 DISTRICT NO GROUP MAP PROCESSED BY /.�y. BK PG CONTRACTOR /1 ADDRESS O ,v L^CONNECTION DATA 'C CITY TEL NO STATION DEPTH ��FlfATE UPPER Tj MANHOLE REFERENCE JON NO REGISTRCOUNTY NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L P ILBLIC SEWER @ $5 00 PC NO SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ 510 00 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ S3 00 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIY EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ S300 ��• OVERFLOW SEEPAGE PIT DRAINFIELD _ Q EXTN CESSPOOL,DRYWELL,MAN HOLE @ S500 ALTER,REPAIR OR ABANDON HOUSE Y OR ID ING ' SEWER OR DISPOSAL SYSTEM @ S300 STATE ENCROACHMENT L PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHA E FEE IHAVE AT 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 OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP,PIT(S) ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/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 COUNTI, AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM TH AL OWNER ,/AND INTEND TO I�D ISCONNECT PLUG ANRESIDE IN THE BO 1 DPROPERTY BANDON HOUSE SEWER SIGNATURE ACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ C ALIDATION ROBERT WOOD Com) M o CASH SUPERVISING MECHANICAL ENGINEER L07- 411:2 JAN 11 1 0 D 5.00- 17