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Home My Public Portal About6437 GOLDEN WEST AVE_Sewer__ CE808 a,-62 76A642D I., APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-S AGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING WILLLIAM A. J NSENCSupti Engineer ADD RE P Building , i LOCALITY G NEAREST FOR APPLICANT TO FII.L IN `ROSS ST, iyt LEGAL �y DESCRIPTION LOT 0 OWNER MAIL BLOCK TRACT. ADDRESS y i NO. OF BLDG5. SIZE OF LOT NOW ON LOT CITY '7-, c TEL. NO. USE OF BUILDINGS DISTRICT NO. BK PG GROUP MAP PROCESSED BY � CONT RACTO / y t ) _ v ADDRESS �� •. /� V CONNECTION ATA /� S, of'J ST N DEPTH /U CITY TEL. NO. S// ` REGISTRATION NO. • a V ❑ COUNTY MANHOLE REFERENCE ' LOWER t NO. DESCRIPTION F WORK FEE T OFC NE 10 ENGTHOM `--- HOUSE SEWER CONNECTING TO Y. M.L.TO L, J a PUBLIC SEWER @ $5.00 /'1 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO. IMP.NO. ` 0 J JOB NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. �` PRIVATE DISPOSAL SYSTEM @ $3.00 JJJ J CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEEIENT RECORD,INSTR,NO, DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSALLI SYSTEM @ $3.00 STATE ENCROACHMENT S PERMIT NO. c,+c INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT $ c s AUTHORIZATION TOTAL FEE 1 /Y/1 CONNECTION CHARGE FEE ITHAVE AT THIS DATE A CONTRACT WIH 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 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND. EWERS. CESSPOOL ElDRYWELL [I] HEREBY CE TIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS EQ ED BV LOS ANGLES COU AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA A I AM THE LEGAL WNER OF, NO INTEND TO DISCONNECT PLUG AND RESIDE IN, T AB VE DESCRIBED DEN AL P OPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS EDOF PER MTTTEE SEEP,PITS) ❑ CESSPOOLS ❑ VALID TIO ROBERT A. WOOD CK. M.O. CASH ( SUPERVISING MECHANICAL ENGINEER I j CES083-62 APPLICATION FOR PERMIT 76A642D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL � DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FDR �] JOHN A. LAMBIE, County Engineer �. 4_1I WILLIAM A. JENSEN, Supt of Building E FOR APPLICANT T FILL IN . LEGAL /` DESCRIPTION LOT N P / O } OWNER BLOCK /A MAIL i+V TRAC/r j&` / ' 1 ADDRESS v NO. OF BLD SIZE OF LOT NOW ON LOT CITY `,.�. TEL. NO. USE OF DISTRICT NO. GROUB MAP PROCESSE BY BUILDINGS � r/ BK PG t CONTRALTO (2 (,�� `� E 0 / ZL ADDRESS Z- � v a,/ CONNECTION DATA STATION ' DEPTH CITY TEL. NO. ��-�1�..✓✓✓ r ///�� S TE UPPER REGISTRATION NO. COUNTY MANHOLE REFERENCE LOWER No. DESCRIPTION OF WORK FEE TYPE HOUSE SEWER CONNECTING TO +" �f.� Y. PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. Y V PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. J JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. s 1/ O PRIVATE DISPOSAL SYSTEM @ $3.00 f� CO NNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVE. E.SEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANH O LE @ $5.00E N ALTER,REPAIR OR ABANDON HOUSE � ^ SEWER OR DISPOSAL SYSTEM HWV.OR ST.WIDENIN83.00 STATE ENCROACH NT PERMIT NO. INDUSTRIAL WASTE APPROVAL _.. OWNER'S PERMIT $ z 00 C'HARG S CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE L 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXI 71 NG DWELLING �L TO THE PUBLIC SEWER. APPROOOYALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PITS) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CO Y ORDINANCES AND STATE LAWS REGULATING PLUMBING A0 S ERS. CESSPOOL ❑ DRYWELL ❑ I HERE CERT FY THAT I AM PROPERLY REC�1 TERED AND/OR ALTER.REPAIR,SEWER OR LICENSED S R UIRED BY LOS ANGLES COUP{71'Y AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFOR I OR HAT I AM THE LEGAL OWNER F, AND INTEND TO DISCONNECT PLUG AND RESIDE N, TH ABOVE DESURIBED R IDENT OPERTY. ABANDON HOUSE SEWER SIGNAT E BACKFILL SEPTIC TANKS ❑ OF PE EE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATIO ROBERT A. WOOD M.O. CASUPERVISING MECHANICAL ENGINEER SH 1 i I1 L' j_ Ij r7