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Home My Public Portal About10112 GREEN ST_Sewer__ 76A 6420 -CE605-10-7L APPLICATION FOR. PERMIT COUNTY OP LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT O�r COUNTYENGINEER QUILDING AND SAFETY bl"SION BUILDING ADDIR 7' f LQCALIT' NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL t. D[SCRIPTION LOT NO. OWNER / MAIL C ISLOK TRACT / 7 & ADDRESS NO. OF DLDO[. �y^ SIZE OR LOT NOW ON LOT CITY t TIIQ- NO. Zd USE OF DISTRICT NO. [ROUP MAP PROL�-Y ■WLDINOE Rps CONTRACT a, T YR ADORE" � CONNECTION DATA �7 CITY TENO. — STATION D[r•fH L G /,., , ST.� LIC I MANN OLE REFERENCEof UPraR LICENSE MO, -/NtS MO.Al ZESCF111PTION OF WORK F[[ TYPk OF CONN[CTIO LENGTH FRbw HOUSE SEWER CONN[CTI No TO ) Y. CURE P.� M.L Td r.L' PUBLIC S[WOR 0 $7.00 // No. SEPTIC TANK.■ of FrT OR OE PITS AND/OR DRAINFIELD 0 510. CO."4P.NO. JOE NO. HOUSE SEW[R COry N[C7 kI;iQ TO TRUNK rERYIT NO. ROAD P[RMrt NO. CL PRIVATE DISPOSAL SY M # 57.00 O CONNECT ADDITIONALIT[ BLDG.OR AFFIDAVIT WA ■ -EASn[RT RECORD.INSR T .NO. 57ATX U WORK TO HOUSE SEWER 0 53_0O OVERFLOW SEEPAGE PrT.DRAINFIELD I OC EI(TN.•CUB POOL.PRYWI(LL- 0 55.00 S 0 ALTER.REPAIR OR ARLANDO N HOUR[ HWS.OR ST.WID[N-ING SEWER OR DIrPOSAL SYSTYM $3.00 STATE ENCROACHMENT MANHOLE i $7.00 IA[RMIT 40. d H INDUSTRIAL Z WASTEAPPROVAL r OWNER'S � a�e- cHA#aEs A UTHOBIZATIONI TOTAL FEE CONN[C-CION CHARGE F[[ 1 HAVE AT THISDATE A CONTRACT WITH THE HEREIN NAMED CON- RE IMBURSEM ENT FB; TRACTOR TO CONNECT THE ASOVE DKSCRPS<D ��}��ff�� R�I TO THE PUBLIC SEWER. i I•'lr OVADAT[ INSPECTOR'S IG MATU R[ SIGNIED T I6 DAYn F, OWNER OR NEW HQU■[S[\h'[R a OWNERS AG[ CONNECT ADDITIONAL ADD SSB BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABQVE IS CORRECT AND AGR[[ TO COMPLY WrTH ALL COU ORDINANCES AND STATE LAWS REGULATING PLU MBINO AND [VN II,RS. CESSPOOL ❑ DRYWILL ❑ I HEREBY RTIFY THAT I AM PROPERLY REGISTERED ANP/OR ALTER,REPAIR.SEWER OR LICENSED REQUIRED BY LOS ANGLES COUNTY AN STATE OF EEWAOE DISPOSAL SYSTIM CALIFORN OR THAT I AM TH[ LEGAL OW-MER OF, A INTEND TO DISCONNECT PLUG AND #E51D[ ABOVE DESCRIBED [NTIA ERTY. ABANDON HOUSE SEWER { SIG L SEPTIC TANKS ElQF M [P.PIT(S) ❑ CESSPOOLS V ON CK. 4.-0- CASH 2335'-4PR A 1 7.00 r 78 Aa4to °' APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEEE BUMDING AND SAFETY DIVISION eulrnlno/O//g 677�)1Y/ S ADDPI W yJ4.yAlL A. Imo. OIIp I O! Q LOCALITY N[AREBT I FOR APPLICANT TO FILL IN `"°'■ /T DESCRIPTION LOT N OW ifLR MAIL BLOCK TMCT _ ADDR[tl NO. OF ■LDOB. LI SIZE OF LOT O MOW ON LOT .11TIL. NO. US[ OF DISTRICT NR O. OROUF MAP POCL ■E SD BY ■UILDINO■ BK b CONTRACTOR t ADDRX28 CONNECTION DATA STATION D[FTH CITY TLL. NO, STATE MAN\ [Rx"R[NCE �R R[OIBTRATION NO. COUNTY L No. DESCRIPTION OF WORK FI[ F FCONN[CTION LLNOTH"OM HODS[B[WItR CONNECTING TO Y. CURE P.L M.L TO P.L PUBLIC■[W ER •8.00 F.C.NO. ■ FTIC A K,B O[FIT OR CD.IMF. NO. JOB NO. O FITS AND/OR DRAI NFI ELD 510.00 V OUSE S[WBR CONNECTING TO TRUNK FIRYIT NO. ROAD F NO. pL PRIVATE DI■POVAL SYSTIM $3.0.0 {� CONNECT ADDITIONAL■ .OR AFFIDAVIT EAn[[ w[ RECORD BTR.NO. ATL WORK TO HOU■[SEW[RSS.00 OVERFLOW SE[FAOE FIT,DRAINFI[LD U[TN.,C[S■1.00L,DRYWELLMAIIHOL[41 $8.00 AL R,R FAIR O ABA D HOUSE O ■ HWM.OR ST.WIDEN ING SEWER OR DISPOSAL SYSTEM 58.00 STATE RICR ACHM"IT F[RMIT NO. INDUSTRIAL ��T�p• n 'nom WASTL APPROVA O Y11iE S PEAMIi s 2 00 CHAROU -0---/' - ONNECTI N CHARD[FI[ AUTHOMATION TOTAL FEE LTA VE AT THIS DATE A CONTRACT WITH TH[ H[R[IN NAMIrD ICON- REIMBURSKM[NT FEE TOR TO CONNECT THE ABOVE DESCRIBED OCISTINO DW LLLINO LRm p HE FUSLIC S[W[R. APPROVALS DATE INSPECTOR'S SIGNATURE ED THIS DAY OF IQ_ [R OR NEW HOUSE S[W[R ER/AO[NT CONNECT ADDITIoNAL BUILDING OR WORK ISS /[PTICTANK.BEIP,PIT(S) [R[SY ACKNOWL[DOE THAT 1 HAV[ READ THIS APPLICATION AHD/OR ORAINFI[LD STATE THAT TH[ ABOVE 19 CORRECT AND AOR[[ TO COMPLY ALL COUNTY ORD IIUINCES AND STATE LAW■ REGULATING BING AND ■EWERS. CESSPOOL �, DIRYW[L.L -Z[R[BY CERTIFY THAT I AY "OPLRLY RIGIIT[R[D AND/OR ALTER.REPAIR•SEWER ORNSED AS REOUIRLD ■Y LOS ANOL[S COUNTY AMD STAT[ OF S[WAOE DISPOSAL SYSTLMFORNIA OR THAT 1 AM TH[ EOAL OWNER OF, AND INTLND TO DISCONNECT PLUG ANOD[ IN, TH[ ABOVI C [ ■IDINTI OY[RTY. ABANDON HOU■[S[W[R A'TURE BACKFILLS[FTIC TANKSFIR 4ITTII r S[[P.FIT(■) u CW FOO LS VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. Y.O. CA/H L�W7 5 8 U�Z UR13 1 0 D 7.00- 70A0642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL OKPARTMKNT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION WILDING JOHN A. LAMDIE. COUNTY KNGINKER A .11 RES/ COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY C ity NEA REST FOE APPLICANT TO FILL IN CROSS 1T AL D LyCRIFT 10N LOT NO. OWNER HAIL BLOCK TRACT /v ADDREBS - NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY same TEL NO. 43 USE OF DIBT111(T NO. GROUP MAP PROCIBSED BY ■U ILDINOI - CONTRACTOR Itt r o 5 C)(5 / 5 /;3 ADDRESS79 V V COPMCTION DATA STATION %34 Di PTH CITY TIL NO. 6 STATE LICLN [ N0. LIC MANHOLE REFERENCE Z/� �`c' 1�. `v LOWLR NO. QESCJRI N 0F WORK FEE TYPE OF CONNECTIb T LENGH FROM r HOU/[■[W 4(CONN[CTI OTO Y. CURS P. M.L TO P.L_ PURLIC/EWER 41 • •00 O ■ IC AN GE PI OR JOB NO. PITS AND/OR DRAINFIELD •10.00 (:O.IMF.HO. JOE NO. yy-. HOU■!/EWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. C.. PRI VATI DISPOSAL SYSTEM •5.00 O CONNECT ADDITIOAL R AFFIDAVIT I EAlRI L&nmzR RECORD.INSTR.NO. DATE U WORK TO HOUSE/EWER a moo, OVERFLOW SEEPAGE FIT.DRAINFIELD O [)CTN_CX"POOLDRYWELLMANHOL.I 0 /1.00 I-_ ALTER. AIR OR AhANCON IAOUAIEHWY.OR ST.WIDENING W SEWER OR DISPOSAL SYSTEM 41 51.00 STATE ENCROACHMENT 0- PERMIT NO. cg INDUSTRIAL WASTE APPROVAL OWNEE"S FERRATE' s : 00 CHAROLB AUTHORIZATION T<)TAL FEE O CONNECTION CHARGE FIl REI M B u RIE M ENT rKr ~';.•'- I HAVE AT PHI/ DAT[ A LORTRACT WITH TMX HEREIN NAMED CON- - TRACTOR TI NNECT THE ABOVE DEjCRIBED []CIBTING DWELLING ��p TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUR SEWER OW NBRS AGENT CONNECT ADOITIONAL ADDRESSBUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BND/OR ANA./,lK,PIT(B) A71D/OR DRAIHFI[LD AND STAT[ THAT THR ABQV[ I■ CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINA14CU AND STATE LAWS- REGULATING PLUMBING AND SEWERS. CZSSPOQL ❑ DRYW.LL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.■EWER OR LICENSED AS R*QUIRED BY LOS ANGLES COUNTY AND ■TATE OF S[WAD[DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A D[SACRIB[D RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE /j' /� -- /, OF PER MrTLK vl /�WH N"� .. ILL S[PT�C TANKS ❑ ■EEr. .IT I■) u CESSPOOLS � a VALIDATION ALL�1 CK. Y.o. CASH SUPERVISING MECHANICAL ENGINEER ►„s 5 7 OR- SI& - 1 1 D 7.00- q