HomeMy Public PortalAbout6042 GOLDEN WEST AVE_Sewer__ 76A6420
4&E-883 3.55 APPLICATION.,FOR PERMIT
•'
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS E55 i
r
CASSATT D.GRIFFIN,SUPT OF BUILo1No ALOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. `-
LEGAL
DESCRIPTION LOT N0. 7k�� •-- - DC7 p OWNER
/ / IMAIL c
BLOCK TRACT r �[�-1 ADDRESS ( r
NO. OF BLDGS. -
SIZE OF LOT c NOW ON LOT CITY I ��i 7.TEL. NO
USE OFBK PG
BUILDINGS l / 4 DISTRICT N0. GROUP MAP y
CONTRACTOR
ADDRESSyp� - Q, CONNECTION DATA
CITY %, �p TEL NO. STATION DEPTH A
STATE MANHOLE REFERENCE � B► UPPER
REGISTRATION NO. ❑�COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE ECTION LENGTH FROM 9
CUP,B 1 M L TO P L
`PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG. ORP C NO.
WORK TO HOUSE SEWER 1 00 CO IMP NO. 13 JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO
�I DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S $ 1 00
AUTHORIZATION I TOTAL FEE' v TS -CONTRACTED
A DWITH THE HEREIN REIMBURSEMENT�FfEE
TRACTORTOCONNE TTHEABOVEDESCR BEDEXIATINGDWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE.PUBLIC-SEWER
SIGNED THIS fAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT
BUILDING OR WORK
t!��
10 !1� f /y{Lr. �..� SEPTIC TANK,SEEP. PIT(S)
ADDRESS
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRY-WELL C3AND 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 +
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY- LOS ANGELES COUNT AND STATE OFDISCONNECT PLUG AND _
CALIFORNIA OR THAT I AM THE LEGAL OWN OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL OPERTY. - BACKFILL SEPTIC TANKS❑ -
SEEP.PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITT - -
WILLIAM J.FOX.-_CENGINEER CM&MAtON R.A.WOOD,-CHIEF PL8G. INSPECTOR"
,Coo 0 6 -!oar 1 io 4 5.50
CE808.e-sa" APPLICATION FOR PERMI:�' _- -
saoe- COUNTY OF LOS ANGELESl
SEWER-SEWAGE ®iSP®SAL . 1
' DEPARTMENT OF COUNTY ENGINEER
BUMMING AND SAFETY DMSION BUILDING
ADDRESS
JOHN A. LAM M County Engineer,
CASSATT D. GR FFIN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL '
DESCRIPTION LOT NO O` R,r OWNER
BLOCK TRACT' MAIL _
ADDRESS- '7
NO.OF LOGS.
SIZE OF LOT W ON LOT CITY L.NO.
USE OF "
�
BUILDINGS �' DlSTRICi GROUP MAP ` PSSED
BK PG
CONTRACTOR' "
ADDRESS - CONNECTION D A
CITY TEL.NO. STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. B COUNTY LOWER
NO. 1. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3.00 TYPE OF CONNECTION 'LENGTH FROM
SEPTIC TgNK,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,MANHOLE @ $2.00
HOUSE SEWER,CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO."IMP.NO. JOB NO. _
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
'.WORK TO HOUSE SEWER @ $1.00
IALTER, '^ 'HOUSE STATE ENCROACHMENT
SEWER^O�� SYSTEM' $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT 3 2100 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE•HEREIN NAMED CON. APPROVALS' DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING-DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS nAY OF 79_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING'OR WORK
SEPTIC TANK, SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
iHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL[3-
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR J
PLUMBING AND SEWERS: SEWAGE DISPOSAL SYSTEM
'1,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 LEGA WNER OF THE ABOVE
DESCRIBED RESIDENTI L PEOPERTY. BACKFILL"SEPTIC TANKS❑
SIGNATURE
SEEP.PIT(S) CESSPOOLS❑
OF PERMIT 'r
®P VALIDATION' ROBERT A.WOOD
_ ps,
H.0, SUPERVISING MECHANICAL ENGINEER
LAS 5 8, 1°0 A FAPR 2 8 1 0 A•" 3.0 0 M