HomeMy Public PortalAbout10014 GREEN ST_Sewer__ 7415-0
7 6A U6&42D 15 APPLICATION FOR PER IT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
B=ING AND SAFETY DIVISION BUILDING
JOHN A.LAYBIE,Counts Engine ADDRESS
COLEMAN W. JENKINS,Sap t. of BolldinsY
LOCALITY
H[AR[1T
FOR APPLICANT TO FILL INLKdAL
DESCRI OH LOT NO. ( OWNER
AMA Al ' AIL
BLOCK TRA t ADDRESS
NO. OFBLDGS.
SIZE OF LOT NOW OX LOT CITY TEL. NO.
USE OF
BUILDING■ SEWERRT a�
X� DISTRICT XO. ORO MAP rIS ■Y
_ fr ■K PG
CONTRACTOR 1317 201 EGROVE
AVE.
ADDRW CONNECTION DATA
��
CITY �'[L NO. STATION . DEPTH
L CENSE
LICENSE UPPt)1
NO. CLASS MANHOLS REFERENCE
NO. DEIIaCRIPTION OF WORK FEE 'rym OF CON NEC, L.ENOTH F M
PUBLIECSEWKRSFWECONNECTING TO S $ D.00 �- Y. CUR■ F.L M.L.TO P.
( F.C.NO.
FIT UH .7
PITS AXD AOR DRAIX"E. 0 $1 0.00 IMP.NO. JOB NO. ^
HOUSE SEWER CONNECTINS TO TRUNK PERMIT N1. ROAD PERMIT NO. `•J{
PRIVATE DI Dl OSAL SYSTEM f $ 9.00
c6wwKtLr ADDIT16NAL 8 bd. OR SAm■ LA Lwr RECORD.INSTR.NO. DATE (�
WORK TO HOUSE AEWER S $ 9.00 }LL`r+JJ
SEWER ABANIIIIN HOUSE
OR DIt
POSAL SYSTEM 0 $ 9.00
HWY.OR■T.WIDENING
E%TN.,CESPOOL
S , MANHbLE S ; 15.00 STATE ENCRCIACHMEN7 2
PERCOLATION TEST 0 ; D.00 PERMIT NO.
INDUSTRIAL
����}}'�7�T7��..p��� WAST[APPROVAL
Onl\r.^ s PERMIT i 2 00 CHARGES
CONNECTION CHARON PEE
AUTHORTLATION TOTAL FEE
'I HAVE AT THISDATE A CONTH
CONTRACT WITH THE HEREIN NAMED CON- R[IM■URSEMEHT FE[
TRACTOR TO CONNECT THE A■OVC D[SCRIS[D
TO THE PUBLIC SEWER. APPROVAIS DATE INSPECT R'S BIGNATU R[
SIGNED THI AY OF 1
OWNER OR1l[W HOUR[SEW
ER p
OWNERS AGENT CONNECT ADDITIONAL
0o BUILDING OR WORK
ADDRESS
SEPTIC TANK,SQFITS)
I HEREBY AGKNOWLEDG THAT I HAVE READ THIS APPLICATION AND/OR DRAINFI[LF,D
AND STAT[ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CLSFOOL El DRYWELL E]PLUMING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED ■ LOS ANGLES COUNTY AND STATE OF SWAG[DISPOSAL SYSTEM
CALIFORNIA OR THE LEO HER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE no
I.ED E ENTI PROPERTY ABANDON HOUSE SEW ER
SIGNATURE ❑
OF PERMITTEE ■ACKFILL SEP[J_C TANKf
SESP,PIT(S) LJ CESSPOOL)
ALIDATION
CK. Y.O. CASH
LAC01 2 7 3ZS Am14 1 0 D 7.00- V
D
S&E-663 11.55 APPLICATION FOR PERMIT 1
S&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
T) CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
NEAREST
F04 APPLICANT TO,FILIIN r CROSS ST.
LEGAL • OWNER
DESCRIPTION LOT N0. F.
MAIL
BLOCK R ADDRESS
NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT —�
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
CONTRACTORcY -��
ADDRESS CONNECTION DATA
CITY TELSTATION DEPTH
N0. .
MANHOLE RE ENCE _ UPPER
/ STATE LOWER
REGISTRATION N0. / _ ju ❑ COUNTY
NO. DESCRIPTION OF WORK' ' FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTI LENGTH FROM
Y. CURB M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD " @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N
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 APPROV
CHAR ES
CONNECTION CHARGE FEE
OWNER'S PERMIT S i 00 1"
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE j
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER- _
SIGNED THS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT" /C SEPTIC TANK,SEEP,PIT(S) .�+
_ADDRESS AND/OR DRAINFIELD '
1 HEREBY ACKNOWLEDGE THAT I 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE V
OWNER OF THE ABOVE
DESCRIBED RESIDENT1 YROPERT�, . BACKFILL SEPTIC TANKS❑
SIGNATURE I 1 SEEP.PIT(S) LlCESSPOOLS[I
OF PERMITTEE
JOHN A. LAMBIE, COUNTY E GINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CC//,JJOK, CASH
t 4947 DEC 9 4 .() 0 a