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HomeMy Public PortalAbout10118 GREEN ST_Sewer__ 7BA942D CE808 8.59 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEW GE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN. Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL J DESCRIPTION LOT N0. . "'T'� t,.f OWNER BLOCK TRACT,c- ( / _ - ttLL MAIL �jJ/ LL{� L'dil'� � ADDRESS 7' PTO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP BK MAP PG -PROCESSED BY CONTRACTOR ADDRES CONNECTION DATA CITY TEL.NO. STATION DEPTH _v JqWr STATE MANHOLE REFERENCE UPPER REGISTRATIO NO. '� COUNTY LOWER NO. DESCRIPTION OF WORK I FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @.$3.00 TYPE OF CONN TION LENGTH M SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L. .L. PITS AND/ORDRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. D PERMIT N0. WORK TO HOUSE SEWER @ $1.00 • SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHM PERMIT NO. INDUSTRIAL WASTE APP AL CHARGES OWNERS PERMIT 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 0 'tj REIMBURSEMENT FEE ` r 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE` TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAtIT!" LD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR 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 DISCONNECT HOUSE D CALIFORNIA OR THA `AM THELE AL OWNER OF THE ABOVE DESCRIBED RESIDENT L ROPER BACKFILL SEPTIC TANKS ❑ SIGNATURE a SEEP.PIT(S) ❑ CESSPOOLS ❑ OF PERMITTE . ®F VALIDATION ROBERT A. WOOD U.0. CASH SUPERVISING MECHANICAL ENGINEER li 6.0 lJ CE8082/70 APPLICATION FOR �EIRMIT 76A 642D i COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION rA ILDING JOHN A. LAMB(E, COUNTY ENGINEER OREss ZCOLEMAN W. JENKINS. SUPT- OF BUILDING CALITY / NEAREST p OR APPLICANT TO FILL IN cRoss sr. (PRINT OR TYPE ONLY) L' �p �/ /� ��q LEGAL - 41 Y�" �j ovv I/ ' •/�4 /// ��I DESCRIPTION LOT NO. OWNER �/J�R//�/f /,j( �/t _- MAIL 33 0 A ©P" / 1 ( BLOCK TRACT ADDRESS O. OF BLDGS. T 7,5'27 ,71 SIZE OF LOT NOW ON LOT CITY J1 TEL. NO. USE OF �C' DISTRICT N0. GROUP CLASS MAP ESSED BY BUILDINGS /`` OE BK PG 60NTRACTOR ADDRESS `D ,/U CONNECTION DATA CITY "STA / i/TEL. NO.. V ///� STATION ��771- /; DEPTH ✓L LICENSE NO� 6 / CLASS '" (i^ MANHOLE REFERENCE/ V ��Z, , Lcallam NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM�� HOUSE SEWER CONNECTING TO J5 Y. CURB P.L M.L.TO P.L. / PUBLIC SEWER 0 $5.00 (/D SEPTIC (ANK.SEEPAGE PIT OR CO.IMP. O. P.C.NO. JOB NO. PITS AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. a PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR RO AFFIDAVIT IY[R [A5[M[KT RECORD.INSTR.NO. DATE O WORK TO MOUSE SEWER @ $3.00 (� � OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 HWY.OR ST.WIDENING 0 ALTER.REPAIR OR ABANDON HOUSE O SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT V PERMIT NO. LLI CL -- - ----- -- INDUSTRIAL V) WASTE APPROVAL Z CHARGES OWNER"S PERMIT $ 00 AUTHORIZATION TOTAL FEE O® CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLISEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER ►.f OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PITS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 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 ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,RE PAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEG L OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABOVE D RI ED SIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE �, BACKFILL SEPTIC TANKS OF PER MtfTEE SEEP.PIT(S) U] CESSPOOLS VALIDATION - JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER CK. W O CASH 7 3 1 :JUL 30 1 0 D 1 6.0 0 ,&jd