HomeMy Public PortalAbout5615-17 GRACEWOOD AVE_Sewer__ D
S&E-663 11.55 APPLICATION FOR PERMIT 1
8&E-6
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT, T4 F L NEAREST.
LEGAL i
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ADD S
N0. OF 13LDtr CITY TEL. NO.
SIZE OF LOT NOW OP LOT
USE OF r ICOUNTY
STRICT NO. GROUP MAP
BK PG
CONTRA TO
CONNECTION DATA
AD E
/ TION5rd DEPTH
C TEL. NO. 7HOLE REFERENCE
IF LOWER
REGISTRATION/0. /0711 ❑
70
NO. DESCRIPTION O�W� FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 , CURB P.L.%` M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
EXTN.,CESSPOOL,DRYWELL,M A N HOLE @ $2.00IMP. N0. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 _TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR / �(� STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE /
I HAVE AT THIS DATE A CONTRACT WIT HE EREIN AMED CON-
_
TAPPROVALS DATE I NSPECTOR�S SIGNATURE
TRACTOR TOCONNE T T E ABOVE DE R ED EXISTING DWELLING y
TO THE PUBLIC SE NEW HOUSE SEWER `
SIGNED THIS Y OF 1 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGEN SEPTIC TANK,SEEP,PITS)
ADD RES / AND/OR DRAINFIELD
I HEREBY ACKNO DYE THAI 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIREQ BY LOS ANGEL COUNTY AND STATE OK ABANDON HOUSE SEWER
CALIFORNIA- OR T I A HE L OWNE 0 E 0 - -
CA(gTF�BUED PR RTY. BACKf
SEEP.P
PIT(SI LL E❑ CESSPOOLS❑
Ofi PERMITTEE '
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIONROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.O. CASH
05375D DEC27 4
5.5 ' 0
379
7681)
CE80808 f 1-57 APPLICATION FOR PERMIT
7
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 5615 GraceWood
JOHN A. LAMBIE. County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building LOCALITY T ler Citi
y 4
FOR APPLICANT TO FILL IN ceoss sr.
LEGAL
DESCRIPTION LOT NO. Q OWNER C. E. Johnson
BLOCK TRACT S _ MAIL
ADDRESS
N0.OF BLDGS.
SIZE OF LOT S NOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS DISTRICTI GRf1j1P MAP
BK P
CONTRACTOR Belvedere Plumbing Co. _�
ADDRESS 11900 EGarvey A @ CONNECTION DATA
CITY El Monte me TEL.NO. GI 8-98Z6 STATION DEPTH
54932STATE
COUNTY MANHOLE REFERENCE UPPER
REGISTRATION NO. LOWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTIO LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXT N.,CES SPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT 1 WORK TO.HOUSE EWER ONAL BLDG.OR @ $1.00 e00
TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHM )
PERMIT NO.
INDUSTRIAL L( L cg '7 t.`.7r
WASTE APPROVAL /�J`' `.J /
CHARGES
OWNERS PERMIT $ 1 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 2.100 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DA INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR /� CONNECT ADDITIONAL
OWNERS AGENT�pBUILDING OR WORK �'"► ��
ADDRESS SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES C UNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGALZz
E ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDE 'VI PROPERTY. BACKFILL SEPTIC TANKS I-]SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE .100
®F VALIDATION ROBERT A. WOOD
CASH SUPERVISING MECHANICAL ENGINEER
4 5 1 AbG 2 8 1 O A 2.0 0 i