HomeMy Public PortalAbout6046 GOLDEN WEST AVE_Sewer__ DEFARTNUMI P OF COUXTz ENGWEER SEWERS AGE DISPOSAL 1
DrVISION, OF BUELDING AND SAFBTY PERMIT APPLI ATION
COUNTY OF LOS ANGELES 01
WILLIAM J. FOX, COUNTY ENOINZER I BUILDING ��
ADDRESS �°'(a /�Jl
FOR APPLICANT
�FIL�®L'I,N, /// �7� LOCALITY / C���'
ADDRESS O (O /[/- //�C��'� / (NG�fi NEAREST v I
CROSS ST.
LOCALITY DISTRICT NO. I Ready for Inspection ( PERMIT NO.
NEAREST ( S
CROSS ST.
RECEIVED BY DATE ISSUED BY DATE
OWNER
MAIL
ADDRESS USE ZONE � '9 C ANCY BK MAP PG
CITY L WO. �3l
CONTRACTOR
CO.IMP.NO. � 6-
ADDRESS SOB NO.
CITY iQ �� TEL.NO. S
TRUNK PERMIT qp;�,,,lz},.
REGISTRATION NO. ® COUNTY ROAD PERMIT N0.` K -
LEGAL ll (J Ir/I STATE ENCROACHMENT
DESCRIPTION LOT NO. �r�f d Y +ell PERMIT NO.
BLOCK TRACT CO�� INDUSTRIAL
N0.OF BLDGB. WASTE APPROVAL
SIZE OF LOT A l NOW ON LOT CHARGES
USE OF �f ��- l /
BUILDINGS >°�' r T CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK// FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER $ 8.50 ✓�� RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD6.OR EXCEPTION RECORDED
WORK 70 HOUSE SEWER 1,00
ALTER OR REPAIR EXISTING NO I DATE (BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR J� `d
_ PITS AND/OR DRAINFIELD 2.00 STATION �/ DEPTH'
CESSPOOL—ORYWELL
SPECIAL CONDITIONS ONLY 2.00 p MANHOLEREFERENCEEFERENCE LOUR
TYPE OF CONNECTION LENGTH FROM yr X O
OWNERS PERMIT ; 1 pp 4% - CURB 222e222eM.L.TO P.L.
AUTHORIZATION I TOTAL FEE ,
4-
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS
DWELLING TO THE PUBLIC SEWER INSPECTOR'S SIGNATURE DATE
•y��
SIGNED THIS:_,:q�L._.__DAY,OFNEW HOUSE SEWER
1 OWNER OR CONNECT ADDITIONAL
OWNERS AGEN ��^ -OR WORK
ADDRESS..( b44.� __•]LAWS
SEPTIC TANK,SEEP.PIT(8)
AND/OR DRAIgF1ELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THISCESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE I8'CORRECT AND
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS_ SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGIAppD/OR LICENSED AS REQUIRED BY LOS ANGELES DISCONNECT PLUG AND
A, STATE OFCALIFORNIA OR THAT I AM THE LEGAABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERBACKFILL SEPTIC TANKS E]SEEP.PIT(8)C] CESSPOOLSXOFSIGNATUREA?OF PERMITTEE__
76A642D SBE;663 4/54 -
APPLICATION,® ® yp�.q� � T
S&E-6D A■ ■ L!CATlON• FOR PERMS
`•Ji&E-663 12-54
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL I�i1
Deportment of County Engineer '
County of Los Angeles BUILDING
VdNE: J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN,SuP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST pp �
CROSS ST. ,/t•�f�lf/••' /LYl
LEGAL a ,
DESCRIPTION LOT N0. OWNER �� �
BLOCK TRACT G f
-ADDRESS �
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS .�+ DISTRICT NO. GROUP MAP
^— e�oti.�� I � I BK PG
CONTRACTOR � � � � f 1177 9
ADDRESS CONNECTION DATA a••�
CITY ..AI TEL. N0. �F� 7 _ STATION - DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO. '7�f'fg / r/� / ❑ COUNTY UPPER LOWER
" Y TYPE OF CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P L M L TO P L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Cg $ 3.50 ,
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSI EM 100
CONNECT ADDITIONAL BLDG OR CO. IMP. NO. JOB NO.
_ WORK TO HOUSE SEWER too-
ALTER
00ALTER OR REPAIR EXISTING
SEVlER OR-DISPOSAL SYSTEM 1 00 ® TRUNK PERMIT NO. ROAD PERMIT NO.
1 _
DISCONNLCT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYS iEM 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
CONNECTION CHARGE FEE'
OWNEWS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE T TOS CONNECTDATE ONTRTHEA ABOVE DESCRIBED EXISTINGCTED WITH THE HEREIN AMED DWELLING APPROVALS DATE INSPECTOR SSIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS BAY O _19 NEW HOUSE SEWER
OWNER OR ! CONNECT ADDITIONAL
OWNERS AGENT _ BUILDING OR WORK
ADDRESS SEPTIC TANK, SEEP, PIT(S) -
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 V alb 7U/NG7sLA f:Jr
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSESEW
CALIFORNIA OR THAT I AM-THE LEGAL OWNER O -THE ABOVE _
DESCRIBED RESIDENTI PROPERTY, BACKFILL SEPTIC TANKS❑ _
" -SEEP.PIT(S) ❑ CESSPOOLS❑
,SIGNATURE ,
OF,PERMITTEE
W /
ILLIM N
AJ.-FOX. COUTY ENGINEER VALIDATION
„BY 3 4' 5',�n MAY 12 4 2.0 0 tD
DEPUTY DEPUTY
s
4
BY BY
`-® - DEPUTY DEPUTY