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Home My Public Portal About10066 GREEN ST_Sewer__ DEP"JVMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLIC LOCALITY T TO FILL I T BUILDING s r NEAREST ADDRESS l CROSS ST. LOCALITY T DISTRICT NO. SERIAL NO. PERMIT NO. C NEAREST A S CROSS ST. RECEIVEO.BY. Ready for Inspection DATE ISSUED OWNER ' MAIL IIA USE ZONEOCCUPANCY ICA6 k ADDRESS ,Q BK PO CITY y,TELAO. / CONTRACTOF �F CO.IMP.NO. ADDRESS JOB N0. CITY TEL.NO. / C i' TRUNK PERMIT NO. STATE REGISTRATION NO. OUI TY ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. _ PERMIT N0. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT // N0.OF BLOGS. /f�^j OJT �JL,'NOW ON LOT CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY / HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLD(S.OR /4XCEPTION RECORDED WORK TO HOUSE SEWER 1.00 — ALTER OR REPAIR EXISTING 0• DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ I 00 Y. CURB P.L. M.L.TO P.L. AUTHORIZATION TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS_/ .......DAY OF. _________19)__� NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT_._ _ _ BUILDING OR WORK –._._._ -- SEPTIC TANK,SEEP.PIT(S) ADDRESS •t•--•�-•- ----,` •--•-- AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL¢ DRYWELL E]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE �y� SEEP.PIT(S)E] CESSPOOLS 0 OF PERMITTEE._- r`�` :-. 76A642A 663 7/53 V Oro CE808 1D0-63 76A642APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �� /� JOHN A. LAMBIE, County Engineer ADDRESS Cif WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST FOR APPLI T TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER E� � � t1mlAIL BA.GG1! TRAO- D DDRESS NO. OF BLDGS.SIZE OF LOT NOW ON LOT ITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROC ED BY BUILDINGS BK PG �� CONTRACTOR.._ Z-'��"'� ' g f 33 -� ADDRESS �,� i1-"-<� CONNECTION DATA CITY TEL. NO. /7` v STATION DEPTH -STATEMANHOLE REFERENC C.J � REGISTRATION NO. COUNTY ER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LEN H FROM HOUSE SEWER CONNECTING TO /1 Y. CURB P.L. M.L. O P.L. a PUBLIC SEWER @ 55.00L/ P.C.NO. C O SEPTIC TANK,SEEPAGE PIT OR e PITS AND/OR DRAINFIELD @ S10.00 N.IMP.NO. JOB NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O^C PRIVATE DISPOSAL SYSTEM @ $3.00 V CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 ri OVERFLOW SEEPAGE PIT,DRAINFIELD IL EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 W ALTER,REPAIR OR ABANDON HOUSE HWY. SEWER OR DISPOSAL SYSTEM IS $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES ' OWNERS PERMIT s 2 00 AUTHORIZATION TOTAL FEE a CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED 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 A &7 - NEW HOUSE SEWER OWNERS AGENT /�jJ � CONNECT ADDITIONAL BUILDING OR WORK _ ADDRESS SEPTIC TANK.SEEP,PITS) I HEREBY ACKNOWLEDGE THAT I HAVE READ TH15 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 A VE DES RIBED RES. EN7IA PROPER Y. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERM ITTE Z.�L�-✓ ❑ SEEP.PIT(S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD CK. M.O. CASH (i. SUPERVISING ME( 7 MECHANICAL ENGINEER o 7 U r n :.J FEBFU 1 0 J .O Ofq v c[eoeAPPLICATION FOR PERMIT �eAa4:D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ■U ADD=ILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CR°" R. OF D[BCRIFTION LOT NO. OWH[R MAIL BLOCK TRACT ADDRW NO. OF ■LDGS. _t !ME OF LOT / NOW ON LOT CIT' TLL NO. US[ OF DISTRICT N0. GROUP ■K MAP PROCEDSED ST BU ILDIHO/ PO V J CONTMRO ADDR CONNECTION.DATA CITY Td. NO RATION DEPTH y �•,� MANH OL[REFERENCE O REGISTRATION NO. COUNTY ♦ LOWER , NO. DESCRIPTI Or—WOR E TYPE OF CONNVTIO L OTH FROM HOUSE/EWER CONNECTING TO Y. CURL .L M.LL TO P.L PUBLIC SEWER 58.00 gltptlCTAMK,f F P • IMF.NO. 1M'N d PITS AHD/OR DRAINFIELD 510.00 HOU/E SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. \ FRIVATE DISPOSAL SYSTEM $5.00 CONNECTADDlYiomAL■ AFFIDAVIT •AfR� WOI[71'T RECO .INSTR.MO. WORK TO HOUSE■EWER 59.00 O OVKIRIOLOW SEEPAGE PIT,DRAINF[OLD (FJj KXTN.,C[/SPOOL,DRYWELL,MANHOL[O $8.00 AL R HWM.OR ST.WIDENING d /EWER OR DISPCSA-L SYSTEM $7.00 STATE ENCROACHMENT UlZ PERMIT NO. INDUSTRIAL WASTE APFROVAL AX OWNER'S PERMT t II oo ARO[/ AUTHORIZATION TOTAL FEE CONNEcrlO A ,I HAYS AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSE NT . TRACTOR TO CONNECT THE ABOVE DL/CRI TO THE PUBLIC SEWS APPR V D T MSP[ IGNATURE BIOMED DAY OF 1 MEW HOU/I f[WD1 MER/AOEolf do COMMLCT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.BEET,PIT(0) I H[R[ ACKN —GGI THAT 1 HAVE A 1/ APPLICATION AND/OR DRAINFIELD AND THA E ABOVE I■ CORRXCT A AO RE TO COMPLY WIT LL dO ORDINANCES AHD ST LAWS REOULATINO FL IN AMD SEW[R/. C[ISPOOL ❑ DRYWLLL ❑ 1 [R[fY CERTIFY THAT I PROPS Y REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED W QUIRANGLES UMTY AND STATE OF SEWAGE DISPOSAL SY"M CALIFORMIA OR THAT 1 AM [ LEO NER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, TH[ ABOVE' CRI■ [MTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL/[P'[�C TANKI OF FERMITTQ SEEP,FST(/� LJ CESSPOOLS vALIDA'1ZQN ----, ROBSING ME A WOOD (` fJ 6UPaRVI81N0 MECHANICAL RliOIN[ER CK. Y.O. `CAIN LACO7 Q 3 s M $ 1 0 D .OQ CANCELLED AT � ur' PL"RiMITiEE