HomeMy Public PortalAbout20134 GRAND AVE_Sewer__D '
f[S0S'-SE APPLICATION FOR. PERMIT -
7QAS4ID
COUNTY OF LOS ANQELE$ _. SEWER--SEWAGE.DISPOSAL
DEPARTMENT Off�** COUNTY ENGINEER
BUILDING AND SAFETY DIVISION edILD Na
JOHN A. LAMBIE. COUNTY ENGINEER Aq DRESS
COLEMAN W. JENKINS. 5UP'T, OF OI-IILDING
LOCALF'CY
NGRSST
FOR APPLICANT TO IN `RGff ST.
I
DESCR ON LOT NO. p OWNER
MAIL
IS LOCK TRACT ADDRESS
NO. OF SLDOS.
IZE OF LOT NOW ON LqT CITY TSL. NO.
BE OF
U IL-DINGS pISTRI No. GROU K MAF PROCESSED■Y
. J JP'3
ONT RA CTO �/ v
A0DR[ea b CONNECMN DATA
d. 6TATION / � ?t7 n�rN �--�
CITY 'CIL. NO.
STATE IC MANHOLE REFERENCV-
�9' U"R
LICEN{[ Nb� D CLAAFS �` 3
NO. DES"]FrrIaN OF WORK FI[ TYPE OF CONNECTIONOT}i FROM 1�
HOU{[■[W[R CONN[CTI NG TO �` Y. CURB .L. .L.TO P.L.
Ef
PUBLIC SEWER 0 $5.00 c V
■[PTIC TANK■[VAC[PIT OR CO,IMP. NO. O• UO
PI`I7 AND/OR DRALNFI ELD $10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PORMIT NO.
PRIVATE DISPOSAL SYSTEM {5.00 O
CONNECT ADDITIONAL BLD(21.OR AFFIDAVIT I ■AFRI iIAl"aff RECORD.INSTR.NO, D4k'rxr
WORK TO HOUSQ SEWER t S&OO
OVERFLOW SEEPAGE PIT.DRAINFI[LD a
[XTN..C[D5POOL.DR"LI,.L.MANHOL[4@ •5.00 {�
ALTER.RLPAIR OR AM DO OU HWY.OR/T.WIDENING Z
a KV""OR DIS,OSAL SYSTEM 7.00
STATE[NCROACHM
PERMIT NO.
INDUSTRIAL
WAST[APPROVAL
CHARGES
OwNis PEHDQT z Oo
AUTHORNZATION[ TOTAL FM 1
�y/ CONNECTION CHARGE FE[
I HAVE AT THI■ DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMSURS[MEN'T FEE
TRACTOR TO CONNECT THE ASQVI q[fCRFEED EXISTING DWELLING �/ o
TO THE PUBLIC SEWER. APPHO•AIS IMAP[CTO R'S S10P ATU R[
SIGNED THIS bAY OF 1D_
OWNER OR ►►' � MEW HOUSE SEWER
OWNERS AGENT� r {/L�, CONNECT ADDITIONAL
ADDRESS Jr ■U ILDI NO OR WORK
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ TFH■ APPLICATION SEPTIC TANK.SELF,PIT(fJ
AND STAT[ THAT THE A■Q9V[ IS CbRRICT AND AGREE
TO COMPLY AND/OI
DRAUV FIELD
WITH ALL COUNTY ORPIHANCES AND STAT[ LAWS REGULATING Ck SI POOL ❑ DRYWILL ❑
PLU MRIN0 AND SEW[RD.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.S[W[R OR
LIC INS[D AS REOUIR L ANGLES COUNTY AMC) STAT[ OF *[WAG[DISPOSAL SY579M
CALIFORNIA OR THAT T LEGAL OWNER OF, AND INTSND TO
LR]BIDX IN, .THE A■ IBLE RESIDENTIAL , AND 1-1 DISCONNECT PLUG AND
ABANDON HOUSE BIWER
TUR[PERMfCT[I BACKFILL SETT ICTANKS ❑
SEEP.PIT(S) ❑ CESS POO r
ALIDATION JACK_ ALL
CK. Y.O. CATH SUPERVISING MECHANICAL ENGINEER
PX008 11-b7 APPLICATION FOR PERMIT
COQ OF LOS ANaF7 SEWER—SEWAGE DISPOSAL.
_
DEPAMOM OF COUNTY ENGUMM
BUILDING AND SAFETY DIVISION hU1LDIllo" .
rOEIN A. T XWRT! ADDRESS
PAW= D. �FnLLocA uTr
FOR APPLICANT TO FII.L W CRm 3
LEGA
60M
ON LOT N0. Z� OWNER
BLOCK TRACT L
D
QI[33-
110.OF BLDQ&
DIVE OF LOT Of ON LOT
cirr TEL.NO.
USfi OF
B IN DISTRICT NO. GBOUP A"
CONTRACTOR 4� _c SK
PD
ADDRESS" COHHECIION DATA
CITY L N0. STATIOR DEPTH
RCOUNTY ■"HOLE REFERENCE UPPER
REGISTRATION N0.
LOWER
No D RJPTI OF'WOW
HOUI$SEVER CONNECTING
To
PUBLIC DI.YHR 3.150
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CORNECTIOYTH FROM
PITS AND/OR DRAINFIELD 0 43.00 T. CURB P.L. TO P.L
WFLOW D AG PIT,DRAIN LD
X. CESSPOO DRTWELL MANHOLE 0 42.00
HOUSE SEWER CONNECTING TO P,C.N0.
PRIVATI DISPOSAL SYSTEM t.00 CO IMP.No. 30B X0.
CONNECT ADDITIONAL BLDG.OR <
■OR1C TO HOUSE SEWER 1.00 TRUNK PERMIT N0. ROAD PER MIT
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL ITSTEN 1.00 STATE ENCROACH�ElIT
PERMIT NO% NV
_ 1NDUDTRIAL
WASTE APPROVA
CHARGES
ovn4EWS PERMrr 00 CONNECTION CHARGE FEE
AUTSOHIY.ATION =OTju, - - - HIMAURSEMBRT FU
I HAVE AT THIS DATE A CONTRA WITH THE HEREIN ■ED CON.
TRACTOR TO CONNECT THE AROVE DESCMIBED EXISTING DWELLING APPROVALS - DATE INSPECTOR'S 316HATURE
TO THE PUBLIC SEVER. _ -- - -- -
sIGNEDTHIs NAT Os� - — - 19 NEW Housa aErErt
OWN-ER OR -- - --- - - - - - -.. _--- - - - --CONNECTADDMONAt---- - - - - ----•- "�
ONHERS AGE][T BUILDING OR WORE
ADDRESS -. - " ' ' '" _ _ _ _ P-�1C TANK,SSP.-PIT�&) -
AN ORDRAINIIIELD-
LHEREHT ACKNOWLEDGE THAT 1 HAVE RE71D TNID APPLICATION
_XTATX THAT,SHE ABOVE IS.FDRRECIJIND-AGRh�"T0. COYPLT -OMPOOL -DRTWXU — - - --ALL COUNNY OIDIRANCES AND STATE LAWS REGULATINGALTHR REPAIR,SEWER OQ
MBING AXD --- .HF3tEBT 'CBR'TIFT THAT`I"71■ FROPERLT REGISTEREDANb/OR -SEWAGE DISPOSAL31ST$■NSED AD UIRED BT 03 ANGEL,EB COUNTT DTA OF D ONNECT PLUG AND
EE.",
IA 1p T- THE, GAL.OWN rim N X HOU T - C LL SEPT C TANKSPIT S CESSPOOLSm1
VALIDATION - -- R2b $
QRT A. woob
u. Qmm 21UPERVIBING hMCHANICAL M,NONS
IER