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HomeMy Public PortalAbout6037-6039 GOLDEN WEST AVE_Sewer__ 76A647D - �� CE8081REV 6/781 APPL CAT NF'O IT _ ©s SEWER - SEWAGE DIS OSAL COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN DISTRICT NO I GROUP BK MAP I ESSED BY PG BUILDING ADDRESS La "•� ��(� /^��S!`'`%"`"•2� 7/�f✓ • CONNECTION DA A LOCALITY PL 4p cf V 1 SDEPTH " NEAREST STATION • CROSS ST UPPER ' MANHOLE REFERENCE LOWER OWNER jV,P TYPE OF CONNECTION "'LENGTH FROM MAIL Y CURB P L M L TO P L ADDRESS PC NO . CO IMP NO JOB NO' CITY TEL NO LEGAL TRUNK PERMIT NO �' ROAD PERMIT NO , DESCRIPTION LOT NO AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE BLOCK TRACT _760-3 NO OF BLDGS t SIZE OF LOT NOW ON LOT HWY OR ST WIDENING USE OF BUILDINGS ` STATE ENCROACHMENT PERMIT NO , INDUSTRIAL CONTRACTOR nI` .. p� /� WASTE APPROVAL ADD oc. ��� CHARGES CITY TEL NO CONNECTION CHARGE FEE '•(- ` STATE /J� LIC REIMBURSEMENT FEE LICENSE NO * CLASS - NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTORS SIGNATURE Q.D HOUSE SEWER CONNECTING TO / � y PUBLIC SEWER NEW HOUSE SEWER /dU77�'(� - SEPTIC TANK SEEPAGE PIT OR - PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM SEPTICCONNECT ADDITIONAL BLDG OR AND/OR DRAINFIELD PIT(S) V� WORK TO HOUSE SEWER - AND/OR DRAINFIELD - ®✓ OVERFLOW SEEPAGE PIT DRAINFIELD CESSPOOL ❑ DRYWELL❑ EXTN CESSPOOL DRYWELL MANHOLE ALTER REPAIR OR ABANDON HOUSE ALTER,REPAIR.SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER , _ BACKFILL SEPTIC TANKS❑ i Permit' s D SEEP,PIT(S)❑ CESSPOOLS❑ OWNER'S VALIDATION AUTHORIZATION I TOTAL"FEE 4 0 0,0'o 1I O 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING o TO THE PUBLIC SEWER R-I - 2,O 1 O O .. SIGNED THIS DAY OF 19_ ®' o o•o aoo5 OWNER OR OWNERS AGENT ADDRESS 0602-80 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY y ��•7 • WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS -- - - - •• I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RE- SIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY SIGNATURE OF PERMITTEE DEPARTMENT OF COUNTY ENGINEER SEWER=SEWAGE, DISPOSAL 1 DIVISION OF BUILDING AND SAFETY i PERMIT APPLICATION COUNTY OF LOS ANGELES j WILLIAM J. FOX, COUNTY ENGINEER + BUILDING l ADDRESS FOR APPLICANT _O FILL IN LOCALITY a BUILDING °NEAREST ADDRESS C� o 9 l�S'. C t CROSS ST. AA Of / ,) LOCALITYj DISTRICT N0. 4 SERIAL NO. JFERMIT-NO. NEAREST A FL5,) Z S CROSS ST. RECE VED BY Ready for Inspection DATEISSUED OWNERS LdNni�� � � � > �a�m�•' MAIL USE ZONE OCCUPANCY MAP ADDRESS // PG CITY TEL.NO. &I; 3 CONTRACTOR — -CO.IMP.NO. ADDRESS �� JOB.NO. CITY t TEL.NO..0-j 7 TRUNK PERMIT NO. REGISTRATION NO. 7 /© �� COUATENTY! ROAD PERMIT NO. LEGAL �. STATE ENCROACHMENT DESCRIPTION LOT NO. PERMIT NO. BLOCK TRACT Ct7 INDUSTRIAL WASTE APPROVAL SIZE OF LOT 10® 41 NOW ON LOTS CHARGES USE OFT ' _ CONNECTION CHARGE FEE B UILDIDINGS NO. DESCRIPTION OF WORK FE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. I DATE I BY 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/OR DRAINFIELD 2.00 STATION 4— 7 ,L- DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANUPPER EFERENC' LIOWER-' TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ II oo , CURB R.L.Q. M.L.TO P.L. .� AUTHORIZATION TOTAL FEE I qy, I. qvi I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED HAVE TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS---------L-4----DAY OF­ HOUSE SEWER C � ��33 , CONNECT ADDITIONAL OWNER OR �/�y"/� f�p�} BUILDING OR WORK OWNERS AGEN _f ��K-�. �-t-�i/' lTf SEPTIC TANK SEEP PIT(3) ADDRESS ------ AND/ORDRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-, CESSPOOL 0 DRYWELL I] CATION AND 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 AND DISCONNECT PLUG A ND/OR'LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AHD STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE AIJOVE DESCRIBED RESIDENTIAL- PROPERTY. BACKFILL SEPTIC TANKS /1 �j'2 Z SIGNATURE BSEEP.PIT(S)I] CESSPOOLS E ✓^ OF PERMITTEE-- ------ --••- 76A642D 663 1/53 1 76A647A - ,CE808(REV 6/781 AP - IC 10 ;.FO MIT ' os SEWER`- SEWAGE D SPOSAL - COUNTY OF LOS ANGELES " BUILDING AND SAFETY FOR APPLICANT TO FILL IN DISTRICT NO GROUP' !;, MAP, ,,"PROC 55ED BY, ' f BK PG BUILDING // !\//� ADDRESS6(3 S9 �° �V� ` y ' CONNECTION DATA . LOCALITY NEAREST STATION / 'DEPTH , CROSS ST UPPER ` __,� MANHOLE REFERENCE LOWER OWNER \SO TYPE OF CONNECTION •' LENGTH FROM^- MAIL - Y CURB PL M L TO P L 1 ADDRESS Pc �46 CO IMP NO JOB NO ' CITY TEL NO LEGAL TRUNK PERMIT NO ROAD PERMIT NO DESCRIPTION LOT NO _ ' ����� AFFIDAVIT' WAIVER EASEMENT RECORD INSTR NO DATE BLOCK TRACT NO OF BLDGS SIZE OF LOT NOW ON LOT HWY OR ST WIDENING USE OF BUILDINGS - STATE ENCROACHMENT PERMIT NO CONTRACTORi-S - INDUSTRIAL •� WASTE APPROVAL r CHARGES ADDR Vq ��••11� �l - "1y CRY TEL NO CONNECTION CHARGE FEE [[ I STATE • LIC '\ REIMBURSEMENT FEE ` ' LICENSE NO CLASS oL. NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR S SIGNATURE HOUSE SEWER CONNECTING TO ' PUBLIC SEWER SEPTIC TANK SEE PAGE PIT OR NEW HOUSE'SE WER Cy G 7fv PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM , CONNECT ADDITIONAL BLDG-OR SEPTIC TANK SEEP,PITIS),. WORK'TO HOUSE SEWER - 'AND/OR DRAINFIELD _ 0 OVERFLOW SEEPAGE PIT,DRAINFIELDE, CESSPOOL [:3DRYWELL❑ EXTN,CESSPOOL.DRYWELL'MANHOLE ALTER RE PAIR OR ABANDON HOUSE 1, ALTER REPAIR SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM ' DISCONNECT PLUG AND -' ABANDON HOUSE SEWER- ' BACKFILL SEPTIC TANKS❑ , OWNER'S Permit , 17�_ SEEP PIT(S)ElCESSPOOLS❑AUTHORIZATION TOTAL FEEVALIDATION ; I(HAVE,AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- 6'�© _ `moi�• /.i—T •��.S rJ,S,P{ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER .'o,(�.� #.p 0,0 O ,+}O SIGNED THIS DAY OF 19_ OWNER OR ., , 1 a'O O OWNERS AGENT , Z O O „ ADDRESS +1 O O -'l a O O 5 .I IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'AND STATE THAT THE ABOVE IS CORRECT AND'AGREE TO COMPLY 0'602-80 O ...pv 0 WITH ALL COUNTY ORDINANCES AND STATE LAWS'REGULATING ' PLU M BING AND SEWERS - - •-- -� - , I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR , LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE'OF .CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RE- SIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY , SIGNATURE - y�A OF PERMITTEE /`►`