HomeMy Public PortalAbout5545 GRACEWOOD AVE_Sewer__ r -
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7eA e41D APPLICATION FOR FERMI
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVIBION FAD.
_ S
JOHN A. LAMBIE, COUNTY ENaINiiR
COLEMAN W. JENKINS. SUr'T. OF BUILDING
FOE APPLICANT TO FILL IN
LEGAL
D LSCRIPTION LOT NO. OWNER
'^ _ MAIL <�
BLOCK TRACT "�J ADORW
NO. OF OLD" f
SIZE OF LOT NOW ON LOT CI N/
USE OF
■UILDINO■ DISTRICT 4knour YAP PROCESS=SY
7 D MK Pa
CONTRACTOR'
r
ADDRESS CONNECTION DAT).
,Il.
CITY L- *---Ti . NO.(Q if _ STATION DEPTH
LI LIC A Z MANHOLE REFERENCEld
LICENSE NO, Pf-7 CLAM L� L04YIR
NO. DESCRIPTION OF WORK FL[ TMP[OF CONNECTION FROM
HOUSE SEWER CONNECTING TO Y. CURB P,L LEN
` M.L. -e I.L.
tIW 41 0 sm.00
SEPTIC TANK, G[ P.C_NO.
PITS AND/OR DRAINFI[LD BIO.00 CO.IMP.NO. JOS NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD P
PRIVATE DISPOBAL SYBTEM 59.00 SAMIT NO.
O
CONNECT ADDITIONAL S .OR AFFIDAVIT Sutn wuuY RECORD.INB711.NO. DA CD
WORK TO HOUSE SEWER 53.00
OVERFLOW•![PAGE PIT.DRAINFI[I CDEETN..CESSPOOL.DRYW[LLLIANHOL[O $0.00 CD
A DON HWY.OR ST.WIDENING
SEWER Is 1 41 S3.00 LLI
STAT[ENCROACHMENT CL
PERMIT NO. Z
INDUSTR AL
WASTE APPROVAL
0WNER"3 PERMIT s 2 OG
AUTHOFMTION TpTAL gp,E CONNECTION CHA O[FEE
I HAVE AT THIS DATE A LORTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT Fix �I
TRACTOR TOQCONNECT THE ABOVE DESCA 10 ED L7(ISTING DWELLING R77R1flOVl1L7
TO THE PUBLIC NEW Arra DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF Ip�
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS
■UILDI Na OR WORK
SEPTIC TANK,BEEP,PIT(Z)
1 HEREBY THAT
THE
AO[ THAT.1 HAVE READ TH I• APPLICATION A-ND/OR DRAINFI[LD
AND STAT[ THAT TH[ ASOV[ I• CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMS
[NO AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REOISY[MED AND/OR ALTER.REPAIR.BEW[R OR
LICENSED AS RkOUIRED SY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL■YST[M
CALIFORNIA OR THAT 1-- THE LEGAL OW R OF, AND INTEND TO DISCONNECT PLUG ANDOle
RESIDE IN, THE A D RIMED R[411 PROPE11T1'. ASANDON HOUBE SEWER
SIGNATURE f/� J MACKFILL S4[J_C TANKS ❑
OF PER MTTTE[ 1 "�^' SEEP.PIT IS) �J CLSBPOOLA El
MMATION JACK R. ALLEN
y O CASH SUPERVISING MECHANICAL ENGINEER
+ 3i21 i o 5.00 ' .Q`
7
D.EPARTARRVT OF COUNTY EN(OrKIM SEWER-SEWAGE DISPOSAL Sqo
DMSION OF BUMDING AND SAFETY PERMIT APPLICATION �
COUNTY OF LOS ANGF2.ffi
WILLIAM J. FOX. CouwrY ENa1N[rR BUILDING
ADDRESS t �m
FOR APPLICANT TO RLJ. IN LOCALITY
BUILDING NEAREST
ADDRESS Fr, OSS ST.
'
LOCALITY IST LICT NO. SERIAL NO. PERMIT NO.
= .� i 11-j,, ', �1�
A :-3 S
OWNER 4 ED 5ff
�f'fK lutea DATE ISSUED
L>A tQ) FF II M41 T L / , '4, - _ �3
MAIL 4221 /1 1 J C USE 20Nfi UPANOY MAP
ADDRESS / : }Lr � BK PS
CITY TELNO. A —/
CONTRACTOR California gover Const.,❑n_ Co.IMP.No.
ADDRESS T Col
JOB N0. -
OITYt;, P� TELR j.o TRUNK PERMIT NO.
REGISTRATION W. 1 5 � �&�IAHTY ROAD PERMIT NO. _
LEGAL // STATE ENCROACHMENT
DESCRIPTION LOT N0. lFl lS N h PERMIT NO.
BLOCK TRACT r �_►r r - ,� `�7 INDUSTRIAL
( WASTE APPROVAL
1 SIZE OF LOT O�3p rj NO.Of &
NOW ON LOTr CHARGES
r
USE OF G
BUILDINGS S CONNECTION CHARGE FEE
NO- DEHCRIPTION OF WORK FEE REIYBURSEY E
HOUSE SEWER OONNEOTING TO /
PUBLIC SEWER i >!M L! RECEIPT NO. DATE ElY
U SEWER N [ ING 0
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD&OA PXtEPTION RE ED
WORK TO HOUSE SEWER IAO
A B PAIR LXIBTINQ DATE BY
SEWER OR DISPOSAL SYSTEM LM
DISCONNECT AND ABANDON SEWER
AND OR DISPOSAL SYSTEM I.06 CONNECTION DATA
TANK,SEPTIC E PIT OR
PITS ANB OR DRAINFIELD 2.100 STATION 7Lo Q DEPTH
SPECIAL CONDITIONS ONLY L00HOLE MANHOLE REFERENCE
i -FOLER A LOWER
TYPE OF CONNECTIP. LENGTH FROIW
OWNERS PERMIT ; I 00 M.L.TO P.L. D
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HERE N NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTO"SIGNATURE DATE
DWELLING TO THE PUQPC SEWER SIGNED THIS" 7 Y OF �` 19 NEW HOUSE SEWER - G C.
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANII((,,SEfiP.PITS)
ADDRESS — AMD/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- OESSPOOL[:] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE El
TO COMPLY WITH ALL OOURTY ORDINAROES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISF'OI<IILSYST R
I HEREBY OERTIFY THAT IAN PROPERLY REGISTERED DISCONNECT PLUS AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEINER
AND STATE OF CALIFORNIA THAT I AM THE LEGAL OWN- ❑
ER OF THE ABOVE D RIB �EBIDENTIAL PROPERTY. SEEP.PIT(S) C TANKS
SIGNATURE
OF PERMITTE I !` f l
TEAOUD 6103 1/63