HomeMy Public PortalAbout10871 GRAND AVE_Sewer__ mow., .� APPLICATION FOR PERMIT 1
ON OF BUELDING AND SAFETY SEWER-SEWAGE DISPOSAL
Dep-t-w2l of Co" Engfn~
�yC Co" of Los A gskis FADDRE"
G
Will.J. FOX. Goumw Enallyml �d CLk§"TT D.a1UFFRNI,Su r oR Ituumima m -FOE APPLICANT TO FILL IN
LEGAL owkER
DESCRIPTION LOT No.
BLOCX' TRACTMAIL ,
ADDRM
N0.OF BLDGS.
SIZE gp/L6T / T O
NOW ON LOT CITY TEL.-NO.
0EH OF
B 1 GE DIMICT NO. G P YAP
SK
CONTRACTOR ��
ADDRE3;l<f� VAl, j' V A � � 1 COPM=ON DATA
CITY r G TEL NO./Q_ / A"/7 IV
/ V STATION DEPTH
❑ STATE MANHOLE REFERENCE ' /� P
REGISTRATION NO.. Y 7 4 ElCOUNTY V
901 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO -G TYPE OF CO�NECTI LENGTH FROM
T CURB L. Y L.TO P.L.PUBLIC SEWER b.60
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL STEM 1.00
CONNECT ADDITIONAL BLDG.OR P. C. N0.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO JOB NO.
r ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT M0. ROAD PERMIT NO.
DISCNNECT AND ABANDON SEWER
p STATE ENCROACHMENT
ANDPOR DISPOSAL SYSTEM 1.00 PERMIT NO.
I SEPTIC T K,SEEPAGE PIT OR INDUSTRIAL
PITS AND OR DRAINFIELD .00
CEESPo L-DRYWELL APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARCEFEE
OWNF$'8 P>�>+[IT s t 00
AUMOMATION TOTu FFA REIMBURSEMENT PEI;
TRACTORI HAVE TO
THIS
BCONNECT�TEETHE ABOVE DESCRIBED E7(IWITH THE EIN STIXGA ED CON-
L)_ING APPROVALS DATE INSPECTOIt'll S•TGMAY UR11
TO THE PUBLIC SEWER �
NEW HOUSE SEWER
SIGNED THIS AY OF 19—
OW NER
9_OWNER ORv CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AEOR DRAINFIELD
IO ACKNOWLEDGE THAT 1 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 SEWERB. ALTER,R EPAIR,DispbsAL SYSTEM
I HERESY IFY THAT I AM PROPERLY REG19TE-RED AND/OR
LICENSED AS UIRED BY LO f AM COUNTY AMD STATE OF DISCONNECT PLUG AND
CALIFORNT R THAT 1 AN THE GAL OWMQ F THE OYE ABANDON HOUSE SEWER
DESCRIBE 1D AL PROPEBTY.N,, EACEFILL S C TAMKS❑
SEEP,PFT(S CESSPOOL
SIGKAT URN
OF PERMITTEE
J.FOX,G&LINTY Et1ammmt VMMAMM R.A.WOOD.CHIP Pua. INspz=R
j J942'N OCT 3 l4 > 0 ►�
7°�ss.ss.��eirfYse APPLICATION FOR PERMIT' 1
•a a
AisoN OF BUmar, AND SAFETY SEWER--SEWAGE DISPOSAL
D.pca�mt of C--ky F-O we.
Cpm of Los Angel» FD
JOHN A. LAMBIE, CouNry ENGINEER O
m CAHBATi D.GRIP"PIN, SUr•T of BUILDING ,
FOR APPLICANT TO FILL IN E
LEGAL OWNER
DESCRIPTION LOT X0. '
BLOCK TRACT 1' MAIL - -
O r C,� ADDREdE
1 N0. OF BLDGS. "'� CITY TEL. M0.
SIZE 0 0 XO■ON LOT
USE OF � DISTRICT N0. GROUP YAP
BU1LD1 GS '
BK PG
CONTRACTOR
ADD /J41 COK DATA
STATION DEPTH
MAIIHOLE REFQIEXCE UPPER
❑ STATE LOWER
REGISTRATION X0. ❑ COURTY
XO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION M.L.LENGTH FROM
Y. CURB P.L. Y.L.TO P.L.
PUBLIC SEWER S 5.60 '
SEPT IS
Tr K,SEEPAGE PIT OR
PITS AND/OR DRALXF1ELD e S 3.00
OVERFLOW SEEPAGR PIT,DRAINFIELD P. C. NO.
EXTN.,CFs6P00L D YWELL MANHOLE 2.00 CO. IVP.X0. JOB XO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SY Y 1.00 TRUNK PERMIT N0. PERMIT X
CONNECT ADDITIONAL BLDG.OR / STATE ENCROACHMENT
WORK TO HOUSE SEWER j 1.00 ` PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSALSYSTEY 4 1.00 WASTE APPROY
CH
C NECTIOX CHARGE FEE
OWNER'S Pmmff S 11 00
AUTHORIZATION Tom FFA 00
REIMBURSEMENT FEE
1 HAVE AT THIt DATE A CONTRACT WITH THE HEREIN NAMED COX- APPROVALS DATE INSPECTOR'SSIONATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EIISTINB DWELLING
TO THE PUBLIC SEWER, MEW HOUSE SEWER
SIGNED THIS- DAY O 19 _ CONNECT ADDITIONAL ^,
OWNER OR BUILDING OR WORK
OWNERS AGKNT SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWEL{.❑ -
AND STATE THAT THE ABOVE If CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. MAGE DISPOSAL SYSTEM
1 "E"' IFY THAT 1 AY PROPERLY GI ED AND/OR pISCONN4CTPLUG AND
LICENSED EO UJ RED BY L ANGELES NTY D STATE OF
CALIFORNOR TH T 1 AN HE LEGAL ER THE ABOVE ABANDON HOUSE SEWER
DESCRIBE ESIDE IAL PROP BAC[I�ILL SElDC TANKS[ISIGNATUR SKEF.PIT S) CESSPOOLS❑
OF PER
JOHN A. LAMBIE UNTY ENGINEER VA NATION ROBERT A.WOOD, CHI[r PL-so. INSPECTOR
cs. X.0. CA."
I An 2036 5 4 2.00 p