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Home My Public Portal About10218 GREEN ST_Sewer__ dA84 2D 75�5 APPLICATION FOR PERMI eA 64 COUNTY OF LOS ANGE�.FS SEWER-SEWAGE DISPOSAL D2PARTb= OF COUNTY ENGINIME BUILDING AND SAFETY DMISION ■U ILD I NQ JJOEN A.LAMBIt, Conat� En&aer AODRIE" J ISG C COLEMAN A. JENCINS,Sap t_of Building }.. LOCALrYY N AR[ST FOR APPLICANT TO FTLI. IN CROSS �. D ESCR PTION LOT NO. OWN4R MAIL BLOCK TRACTADDR[SIS �� l' Cog C g NO. OF ■LDOS. SIZE OF LOT V I NOW ON LOT r-ATIOlt Y TEL. NO. USE OF TRIC7 NO. GROUP YAP M10CUS Y ,SUILDINO' ■K P6 CONTRACTOR b — / k zo�� ADDRESa CONNECTION DATA DEPTHCITY 0LICENSE LIDS NIE H OLR It[fi R[NC[ UPPER N0. GL.ABS LOWER NO. DESCRIPTION OF WQRK FE[ TVP[OF CONN[CTIO?4 LE'N107H FROM HOUii SEWER CONNECTINS TO Y. CURD P. M.L.TO P.L. PUBLIC SEWER S $ 5.00 PLG NO. TITS ANO/OR DRAINFIELD • $10.00 CO,.IMP, NO. �a"MO• HOUSE SEWER CON ECTINS TO TRUNK PERMIT NO. ROAD PJRMrT NO. PRIVATE DISPOSA4 SYSTEM ! $ 9.00 AFFIDAVIT Sams I waBUTRECORD. IHSTR.NO. qATIIE WORK TO HOUSE 95WER S' $ 9,00 SEWER OR DISPOSAL SYSTEM S # 9.00 HWY.OR ST.WIDEN NO d E%TN_,CESSPOOL, MANHOLE f 5.00 STATE WCROACHM[NT P[RCQLATION TEST I i 5.00 PERMIT NO. INDUBTRIAk WAST[APPROVAL OWN rS PERMN ; 2 00 IMA AUTHOR=TION TOTAL FE CONN[CTIQNICHARpw FEE '1 HAVE AT THIS DAT[ A CONTRACT WITH TH[ HEREIN NIA,M[p CON- REIMBURSEMENT F[[ TRACTQR TO CONNECT THE ABOVE Dt9CRIBED 6)CISTINO �W[LLINb TO THE PUBLIC SEWER. ROvAT R DATE IN'P[CTOR'S SIQNAtUR[ SIGNED THIS DAY OP IG_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,S[[!,PIT(S) I H[R"Y ACKHOWL[DOE THAT I kIAVL READ. THIS I■ APPLICATION AND/OR DRAIN FIKLD AND STAT[ THAT THEABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND 1TATE LAWS R[OUL.ATINO CEaIPOOL El DRYWELL ❑ PLU MBINO AND SEWERS. IHEREBY CERTIFY THAT I ,AM PROPERLY MROIST[RED AND/OR AI,.TER,REPAIR,SEWER OR L IC Y.NbED AS RBOOIRED BY L-08 ANGLES COUNTY AND STAT[ OF SI WAG[DISPOSAL SYSTEM CALIFORNIA OR THAT I M E L[OAL OWNER F PID INT'RNP TO DISCO N[Cr PLUO AND RESIDE IN, THE ABO r R[sI DEHi ROPERTY. ABANDON HOUSE SEWER SIOPIATLJt[ BACKFILL SEPTIC TANKS ❑ OF PERML ��7�� PS}ER�P IT 19) ❑ CEJ{�POO LIS VIILLJJAl1Oiy jL0 2 •3.7 ',2 Z8 w 31 8 1 D 2 4 0.0 p► • FFA ofrv�-��o-- . �� Zy 76A84;D APPLICATIO FOR PERM T 7 6A B4 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL. D$PARTB= OF COUNTY ENGINEER BVILDING AND SAFETY DIVISION LU ILDI P4 0 19M A.L.AMBIE,Lounty Eq&ocr —Ego 14 AK COLI;iIAN W. JENL NS,Sop t. of Bdlidins LOCALITY � r NEAREST ! FOR APPLICANT` TO FILL IN cRo[e nr. DESCRIrriKOALON LOT NO. OWNER MAIL BLOCK TRACT X" � ADDRESS NO. OF ISS. RIZ[ OF LOT NOW ON LOT CITY T[L. N USE OF AUI-DINGS r `4�1•`TRICT HO. 9ROUr MAF! FROC[D Ii.D BY CON7RACTO _5'—w _rK—!" ADDRESb `CO ON DATA, CITY T STATION D[TTFf LICENSE LICE NO. C"1 5 J MANHOLE REFERENCE 7 ISO N MESCRIFfION OF WORK' FEE TYFE OF CONNECTION LENGTH"OM_' HOUBE BE CONNECTING TO C,UR■ ?.L. M.L_TO P.L. PUBLIC BE�Y1V'EER • $ 5.00 P.D NO. z�6 P ITR AMD/OR DRA6NFIELD • $10.00 CO.IMF. Hp. JOB NO. HOUDE SLWER CONNECTING TO TRUNK P"MIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL DYSTEM • $ 3.00 4 0 NN r CT Q R AFFIDAVIT I [Arno EA![G[ RECORD.INGTR.NO. DAT[ WORK TO HOUSE IIE:;R 0 $ 9,00 J BE EWER OR DISPObAL SYSTEMRE NOON m • $ 3.00 RIEVAIE AINFItLu HWY.OR ST.WID[NI HO [X T1i.,C,[BDPOOL, MANHOLE • 5.00 STAT[ENCROACHMENT PERCOLATION TEST 0 15.00 PERMIT NO. INbU&TRIAL WASTE APPROVAL CHARa[1 O�Vmarg PERMIT i 2 0 AUTHORIZATION TOTAL CONNECTION CHARD[F[[ 1 HAVE AT THIS DATE A CONTRACT WITH TH[ R[R[IN NAMEDCpl{- REIMDS UREM[HT FEE TRACTpR To CONNECT THE ABOVE DkaCRISB lExifTiNg DWEL L INGDW EL L IND TO THE PUBLIC SEWER, APPROVALS DATE INSPE R'S SIGNATURE 816N-ED THPSAY OP' T� OWNER OR NEW HOUSE SEWER r OWNERS AGENT CONNECT ADDITIONAL ■LHLDING OR WORK ADDRESS ■KPTIC TANK,AKEP,PIT(S) I HERESY ACKNOWLEDGE THAT 7 HAVE READ THIS ATPLICATION AND/OR DRAINFIELD AND STATE TEAT THE A'DOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATS LAWS REGULATING CESSPOOL El DRYW[LL [IFLU Mo INN AND SEW". i RER[RY CERTIFY THAT 1 AM PROPERLY REGISTERED .1ND/OR ALTERE ,REPAIR,Rw[R OR LICE NRED AS REQ BY LOS ANQLEQ COUNTY AND STATE OF SET WAGE DISPOSAL SYSEM CALIFORNIA OR AS AM TME LEGAL OWNER OF, D iNTEND TO DISCONNECT P6UQ AND REDID[ LN, TH [SCRIS[D ID6 AL OPERTY. AEAHDON HOUSE SEWER lit SIGNATURE t OF P[RMI � BACKFILL S4IC TANKS ❑ BE". PIT(R) LJ ctasroou YAI.ID CK. M.O.. CASH CASH LAL02 3 7 '3Z8 MAY 31 1 0 0 7.00" C5608 64Yo70 r - APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENCi1NEER BUILDI" AND 8Af DIVISION ■UIL�INa f2 1p JOHN A. LAMBIE. COUNTY ENOIN[L!! ADDR[ra COLEMAN W. JENKINS. SUPT. of BUILDING LOCALITY Apo -1 APPLICANT Y O PILL IN M[A REST (PRLNT QR TYPE QNLY)GAL cR«� ST DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADORE" Md. OF ■LOGS. SIZI OF LOT NOW ON LOT CIT1C NO. r� USE OF DIQTRIC7 RQ, OUP CLASS MAR PRO ESSED Y BUILDINGS ■R PE QONTRACTOR ..+ 1 2V!�z ADDRtfS COMOCnON DATA P� [ [TATION D�IH CITYre ow TILL. NO. V W RTA TL LIC MAINHOLK REFERENCE LIC[Nlf N6, u LOW" NO. .DESCRIPTION OF WORK I" TYPE OF CONNECTION LINQTH M MpU L SLWR CONN[(.TINO TO Y. CURB P1. M.L.TO P. PUBLIC SLWR SS.00 T.C.NO. SEPTIC TANK,SEEPAGE P ott r ITS AND/OR DRAINFIELD SIO.00 CO.IMP.NO. X10■NO. HOUSE SEWR CONNLCTINGTO TRUNKTERMIT NO. ROAD PLRMIT Nq. PRIVATE DISPOBAL SYSTEM S3.00 (� CONNECT ADDITIONAL AFFIDAVIT B�ITO "wrBElT RECORD.INSTR.N TE T: WORK TO HOUSE SLWO a $3.00 FVV OVRFLOW SEEPAGE PIT.D1IAINFIELD Ot EXTN.,GLSSfIOOLDRYWELL MANHO E 4b 55.00 O ALTER.REPAIR OR ABANDON HWY.OR R.WIDRNINd' , SEWER OR DISPOSAL SYSTEM 7,00 STAT[KNCROACHMENT S PERMIT NO, d -F- IPIDUWMIAL H WAITK APPROVAL Z_ O P�EM�M lT^�p1 CHARGR : CONNECTION CHALK FEE AumoE P noN TOTAL FEE I HAVE AT TH48 DATE A CONTRACS WITH THE HEREIN NAMED CON, RLI MSU ME MINT FIE 7RI.GTOR TO CONNECT THE ABOVE DESCRIBED 6XIBTING DW LLLING TO THE PUBLIC SEWR. APPROVALS DATE INkP[CTOR'S SIGNATU R[ SIGNED THJB_DAY QP OWNR OR ml W HOUSE SEWER OWNERS ApENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,BEEP.FITS) I HL-R[SY ACKNOWLEDGE THAT I HAVE RfAb THIS APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT AND AGR[[ TO COMPLY ANO/OM DRAINFI[l.D WITH ALL COUNTY ORDINANCES AND STAT[ LAWS R[GULAYINO PLUMBING AND SEWERS. CESE'POOL ElDRYWZLL I HEREBY CERTIFY THAT,I AM PROPERLY REGISTRm AND/OR ALTS R;RSPA I R.SEWS OR LICENSED AS REQUIRED BY LOS ANGLES-COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM CA LIT ORN IA OR THAT I AM THE LEGAL OWNER ON, AND INTEND TO DISCONNECT PLUG AND REBID[ IN, ITIS A■ CRI BE R[li IAL PROP[11TY. ABANDON HOUSE SEWER SIGNATURE OF PR MTTTQ �.,./ SACKPILL SLP�C TANKS Q SEEP.PITT/} CESSPOOLS li( I.IDATION JACK R. ALLAN SUPERVISING MECHANICAL ENGINEER CK. M.O. CMH I fir_ 6 15'9 1 2 1 3 9 5DO"