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Home My Public Portal About10765 GRAND AVE_Sewer__ 20 APPLICATION FORPER IT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS ,� 7 WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CRoss sr. LEGAL DESCRIPTION LOT NO. _ 1JC1s13/ Z OWNER MAIL BLOCK TRACT ADDRESS r NO. OF BLDGS. SIZE OF LOT / J NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROC D BY BUILDINGS v BK_— PG CONTRACTOR It PIL h (yU/ ADDRESS CONNECTION DATA CITY 1 J TEL. NO. I O STATION DEPTH • ❑ STATE UPPER >_MANHOLE REFERENCE C REGISTRATION NO. ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM O HOUSE SEWER CONNECTING TO Y. CURB P.L. M. .TO P.L. (J PUBLIC SEWER @ $5.00 P SEPTIC TANK,SEEPAGE PIT OR PITS AN INFIELD C� SIO.00 U NO- O HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ S3.00 TRUNK PERMIT NO. ROAD PERMIT NO. 11�'LJ- CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE CL WORK TO HOUSE SEWER @ 13.00 N OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE a 55.00 ALTER, HOUSE HWY.OR ST.WIDENING SEWER Do M5F1 Al =YSTEM @ 53 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S A I PERMIT $ 21 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I 105T 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONLIC SEWER. THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR , LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I THE LEGALMSOWNEF, AND INTEND TODISCONNECT PLUG AND RESIDE IN, THE ABOV D SCRIBEDPROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ G M.OCASH LIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER . �tl,o 3 9 3 3 0 DEC 5 ri 1 '? D 5.0 0'' s: ym� A642- 76 A 808 3 D 62 APPLICATION FOR PERMIT 642 •�- COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION NG7 JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL �^ DESCRIPTION LOT NO. %J OWNER MAIL BLOCK TRACT 3 3 ADDRESS NO. OF#BLDGS. SIZE OF LOT NOW ON LOT L CITY TEL. NO. USE OF DISTRACT NO. GROUP MAP PROCESSED BY BUILDINGS '� of j.� /p/� BK PG CONTRACTOR e.✓ { V //� ADDRESS ® CONNECTION(DATA Lffo STATION -74 DEPTH CIT TEL. NO. �J STATEUPPER REGISTRATION NO. GOUNTY MANHOLE REFERENCE a N DESCRIPT ON OF WORK FEE 046 TYPE OF CONNECTION LENGTH F OM • HOUSE SEWER CONNECTING TO r� Y. CURB .L. M.L.TO .L. > PUBLIC SEWER @ $5.00 -! I �1 SEPTIC TANK,SEEPAGE PIT OR / P.C.NO. VV PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. Z JOB NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD,INSTR,NO. DATE WORK TO HOUSE SEWER C $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 HWY.OR ST.WIDENING ALTER,REPAIR OR ABANDON HOUSE - SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS CHARGES •r1�IL PERMIT S 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN 1AMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWE — N APPROVALS DATE INSPECTOR'S SIGTURE SIGNED THIS DAY OF 19 OWNE OR R NEW HOUSE SEWER OWNERS AGENT ` CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ._-- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATIN El AND SEWERS. CESSPOOL ElDRYWELL I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEW AGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB905 DESCR BED RESI ENTIAL ROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS El SEEP,PIT(SI ❑ CESSPOOL VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. 62 r 2'7° 76A6A 642D APPLICATION FOR PERMIT 6 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FLO ILDING JOHN A. LAMBIE, COUNTY ENGINEER DRESS COLEMAN W. JENKINS. SUPT. OF BUILDING �—� CALITY NEAREST FOR APPLICANT TO FILL IN CRosS ST. G p (PRINT OR TYPE ONLY) A LEGAL ! �! DESCRIPTION LOT NO. � 31 OWNER MAIL BLOCK TRACT / ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. Y USE OF DISTRICT NO. GROUP CLASS MAP PROCESSED BY BUILDINGS _j,,, B///K�� p G CONTRACTOR fV V C� j/ ADDRESS CONNECTION DATA CITY TEL. NO. STATION DEPTH STATE LICUPPER LICENSE NO. CLASS MANHOLE REFERENCE LOWER NO, j DESCRTPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER a $5.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 R CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIY[II 1451"INT RECORD.INSTR.NO. DATE O WORK TO HOUSE SEWER @ $3.00 U OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL.MANHOLE Q $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING Q SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT / (J PERMIT NO. W CL - INDUSTRIAL cn - WASTE APPROVAL Z CHARGES OWNERS PERMIT s o0 AUTHORIZATION TOTAL FEE ^ CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRT�D„ RESIDENTIAL PROP$RTY. ABANDON HOUSE SEWER SIGNATURE 1"�. ❑ OF PERMfTTEEZ. ( _ /'� BACKFILL SEPTIC TANKS SEEP.PIT(5) ❑ CESSPOOLS ❑ VALIDArTION'� JACK R. ALLEN /// SUPERVISING MECHANICAL ENGINEER CK. M.q C� Li"ltrfl r 7' 1E r? fw' 6