HomeMy Public PortalAbout10202 GREEN ST_Sewer__ I
7U&42D D5-85APPLICATION FOR PERMIT
7SA.S4
-COUNTY OF LOa ANGE1.Fli $EWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINgM
$=ENG AND 9XFETY D"ION au1LDINa
`JOHN A_LAMB[E, Counts Engineer ADD.[Dl
COLEMAN A. JENUNS,Sap t. of BuiLdins o
LOCALITY
NEAREST
rOR APPLICANT TO FILL IN CROSS ST.
IK L
D[aCRIFTION LOT NO. OWNER
MAIL
■LOCK TRACT ADDRX95
H O f BLD 0S. r
SIZE OF LOT NOW CSN LOT CITy 44A 1Tti.. NO.
USE OF DIfT7tICT GROUP Y
■UILDINOR AF RROC[6S[D lY
CONTRACTOR Ow/V �� ,,r \
ADDRESS CONNECTION DATA
CITY TEL. NO. - STATION f ' DEFTH,H
LICENSE LlqE-MSIZ
CLAS&
H0. CLADL MANF{OLE REFERENCE
(f
NO. DESCRIPTION OF WOK FE[ TYPE OF EFR
CONNIKCT1ON LNaT}f OM
H OURE SEWER CONNECTING TO 11:v Y CORE F F.L. M.L.TO f.L.
2%,rC SEWER 0 ; 0.00 {/(/5Erl-AGE PIT OR O >_d
PITS AND/OR�DRAI-MFIE.LD • $10.00 CO,IMP. NO O• 452: 6 O
HOUSE SEWER CO NECTINS TO ,TRUNK PERMIT NO. AD PERMIT NO. - V
PA IVATE DFSPOSAL SYSTEM S -$ 3.00
CO MF!TT G. OR AFFIDAVIT SAmIl ll1EI1lR I RECORD.INSTR.NO. DATE O
WORK TO HOUSE SEWER • $ 9.00
ABANP5-w HOUSE
SEWER OR 013 POSAL, SYSTEM 0 $ 3.00
HWY.OR LT.WIQENINO
EJ(TN.,CESS POOL, FA.A NHOLE • 5.00 CIO
STA—XNCIR ACrHMENT
PERCOLATION TEST S $ 5.001 PERMIT MO.
-INDUSTRIAL
WASTE AFFROVAL
n��� CHARD[S
O��� NE S PE$M T il .',21 00 dP
A=OREATION TOTAL FEE LONNECTION CHARQL FEL L �•- O,
-1 HAV[ AT THIB DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURS[MFNT FEE
TRACTOR TO CON NSCT THE ABOVE DESCRIBED EXISTING DWELLING
TO TR[ FUrBLId IEWEII. AMQVAIR'
rS DAT[ INS{[ /SIQNATURE
SIGNED THI$ DAY OF 18_
OWPJ"OR NEW ROUT[S[WIR IV
OWN[h5 Aa[NT CONN[C7 ADDITIONAL
AQDRIBS SUILPING OR WQRK
t •H ER[SY ACKNOW L[DO[ THAT 1 HAV[ READ THIS SEPTIC TANK.PEEP,PIT(9)
/1PPi,ICATION AND/OR DftAINFIELD
AHD STATE THAT THC ABOVE IS C.ORR[CT AND AGREE TO C6MPLY
WJTHALL COUNTY ORDINANCES AND ( E TATLAWS REGUL,ATIKO
FLUM■ E [
[NO AND SWRl. CLSSPOOL ❑ DRYW[L L ❑
I HEREBY CERTf FY THAT I AM PROPERLY R[aI ST[R[D AND/OR ALTER,REPAIR,SEINER OR
LICENSED " REQUIRED BY LQB ANOL[S COUNTY AND STATE OF SEWAGE DISPOSAL SY97XM
CALIFORW.A\ OII THAT I AM THE LEGAL OW [R OF, AND INTEND TO
'DI6CONN[CT PLUG AND
RESIDE IN, THE VE DESCRIBED ESID TIAL PRO P[RTY. ABANDON HOUSE SEWER
SIONATURF BACKFILL S[ IC TANKS El
OF, (/) L] CI'SS PO QYIUMLS Lr'�
ATIO
M.O. CASH r
'i012 -7 4 8�8 X13 8 a n 1 800 ••04
� 2'7as� X413 Yo D 7,00-
, .�; _
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;;°84X-L APPLICATI N FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL u
DEPARTMENT OF COUNTY ENGINEER
BUILDIN4 AND SAFETY DIVISION rL
ILDI o
D
CAL • v ��''/ ..
FOR APPLICANT TO FILL IN .■ ■T V � N y�
DESCR IFTION LOT NO. Z-2 QWNFR
Q / MAIL 61
BLOCK TRACT M Z / �� / ADDRESS aim
NO. OF SLDO■.
SIZ OrAcNOW ON LOT CITY 'rR No.
U/ O DISTRICT N0. R UP MAT CESSED EY
s I ■ EK PS
N
COTRACTO leg
f,:g
AbDREb i - CONNECTION DATA
TILL. NO. y STATION �� gErTH
64 TA TELIC MANHOLE REFERENCE l UPT'Q1
LIG[NS[ NO. GI-A ✓
N DESIPYION OF WORK FEE TYPE OR CONNECTION LENGTH FROM
HOU■[R[WRR CONN[GTING TO Y. -_CURS F.L M,L.TO P.L
RU CLIC/[W EF d �.
PT TANK.■[[FAO[Frf OR F.C.NO.
FITS AND/OR DRAINFIELO CO.IMF.NO. JO■NO. O
HODS[SEWER CONN[CTINOTO TRUNK PERMIT NO. ROAD PERMIT NO. V
PRIVATE DISPOSAL SYSTEM 0 cc
CONNECT ADDITIONAL■ .OR AFFIDAVIT I WA Km I WL/E7T RECORD.INSTR.NO. DATE 0
-WORK TO HOUSE SEWER 0 0
V FLOW SEEPAGE PIT.DRAINFIELD
■XTN,.CK■GPOOI-. RYWRL.MANHOLE O
ALI..REPAIR OR ASA ON HOUSEHWY.OR ST.WIDENING d
SEWER OR DISPOSAL■YE TEM STA [fl RO CHMENT H
Z
PERMIT NO.
NbUSTR AL
WASTE APPROVAL
OWNER s 1 T = O CHATOU
1�UTH0ETLATION TOTAL Fm `O D V� CONNECTION CHARa[f[I
I HAVS AT THISDATE A CONTRACT WITH T4-1- HEREIN N MILD{ON- RZIMEH
URE[M[ T FEE
TRACTOR TO CON"XCT TH[ ASO VE DUCRII[D [xIFfING DWELLING
TO THE FUSLIC SEWER. OVALS DAT[ INSFS,CTQR'S SIGNATURE
SIGN@d THIS, DAY 4 +M—
OWNER OR NEW HOUSE SEWER
OWNERS AO[NT- 9_� �, CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
I H[R[CY ACKNOWLEDGETHAT F HAVE READ THIS APPLICATION SEPTICTANK. FIKI PIT(/)
AND/OR pR.AINFIELD
AHD STAT[ TTAT THE ARQV4 i/ CORRECT AND AOR[[ TO COMELY
WITH ALL COUNTY ORDINjkNCES AND STATE LAWS REGULATING
FLP MB
ING AND ■EWERS. CESSPOOL Q bRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY R[O7RTERED -AND/OR ALTER.REPAIR.SEWER OR
LICEN■[D AS R LKD3 (-O■ ANGLE■ OUNTY AND STA OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA H[ LEGAL O [R OF, AHD rNTE TO SCONN[CT FLUO ♦ND
E/IDE IH, R I NTIAL P ARANbON HOU■[SEWER
f I GNATUR BACKFILL SEPTT TANK/ Q
OF PER KEP.PIT(■I L CK"POQLA
VALID
CK. M.0 CA/H
6 S 29M t3.1 0 0 9.0 0 A98