HomeMy Public PortalAbout10221 GREEN ST_Sewer__ I � J
d" APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE
DEPARTMENT OF COUNTY ENGINEEB EWA DISPOSAL
BUILDING AND SAFETY DIVISION ■u1LD1nG
JOHN A. TIME)LTP_ py
ux ADDRasB
IVILLA. Iz�.Su of
LOCALITY
HIAREDT
FOR APPLICANT TO FIN °"°°' /T.
ILA.
DESCRIPTION LOT NO. �wr, �]— ) OW NIR
z1olff Pk
MA L
BLOCK TRACT O I • ' ADDIRIC"
NO. OF BLDGS. �^ ^
Z IZE OF LOT NOW ON LOT CETY L. NO. l
UOE OF
i SUILDINOD lD�I t�fT�R I^CYTIN O. GROUP OK
�-y MA'P EY
r CONTRACTOR
ADDRESS a - rct.i n CONFECTION DATA
CITY TEL NO.
I\ [TATION DEPTH
SATE MANHOLE REFERENCE UPPER
R[019TRATION NO. COUNTY LOWIlI
NO. DESCRIPTION OF WORK FI[ TYPE OF CONNECTION Lilmal
HOUBE BEWEt CONNECT NO TO Y. CURE P.L M.L TO P.L V
1 'PUBLIC[EWER sa.00
PT IC TAHK, FAO[{ OR P.C.NO. x
FITS AND/OR DRAINFIIL.D SIO.00 CO.IMP.NO. JOE NO.
GUS[[EWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM it.00
GONN CT ADDITIONAL 0.OR `^ AFFIDAVIT [AIIEQT RECORD.INSTR.NO. DAT[ N
WORK TO HOUSE SEWER $3.00
OVIRFLOW SEEPAGE PIT,DRAINFIELD
LXTN.,CESSPOOLDRYWE..L.MANHOLE $3.00
ALTtR,RtPAIAt OR ABANDON GUS[
EID O
• WER OR DISPOSAL QYSTEMI 7.00 STATE EiCROACHMENT
PERMIT NO.
INDUSTRIAL
������T7��ppi�pp WAIT[APPROVAL
OWNENS J FE mT $ 00 CHAR
i,
AUTHORIZATION TOTAL FEE CONNECTION CHARD[
1 HAVE AT THISDATE A tOW ALT WITH THE H[R[IN HAM[D CON. REIMBURSEM �V
TRACTOR TO CONNECT THE ABOVE DESCRIBED QISTIN9 DW ELLINO
TO THE PUBLIC SEWER. AMOVA%M DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 1D_
OWNER OR NEW HOURZ SEWER
OWNERS AGENT CONNECT
ApDITIONAL 0
ADDRL/S BUILDING OR WORK
SQTIC TANK,SEEP,PIT(B)
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH I• APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE I• CORRECT AND AGREE TO COMPLY
WITH ALL COUKTY ORDINANCES AND STATE LAWS REGULATENG SPOOL ❑ DRYW[r r ❑ r
PLUMBING AND SEWERS.
I H[E1[BY CERTIFY FY THAT I AM FROPEHLY R[GIST[RID AHD/OR ALTER,RPAIR,SEWER OR
LI CINSED AS
REQUIRED BY LO} ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEKD TO DISCONNECT PLUG AND
RESIDE IH, THE ABO V[ D[fCRIBm RESID[M1AL PROPERTY. AEAN DON HOVE[SEWER
•10 KATU RE BACKFILL SEPTIC TANKS ❑
OF I"M m-vx ■REP.PIT(S) ❑ CESSPOOLS
A MATIO14 ROBERT A. WOOD
CK. -.0.
CMH SUPERWN
SING MECHANICAL ENGINEER
3 1 9 5-0 JUN 29 1 0 D 5.00~
7GA64sD APPLICATION FO PERMIT
Tewe{
COUNTY OF LOB ANGELES SEWER—SEWAGE DISPOSAL
DEPARTNMNT OF COUNTY ENGRM
BUMDING AND SAFETY DrWSION eu1LDING
JOHN A. LMOTF CcumAT EnWn~
ADO R[ll
A. TEMSEN, 9"'f cd InUcong
LOCALITY
N;AR[rf
FOR APPLICANT TO FILL IN "'°1° 'T
LIKOAL
DESCRIPTION LOT NO. 1 OW NSR ,
MAIL
BLOCK TRACT ADORES" V
r, NO. OF ■LDGS.
SIZE OF LOT a d HOW ON LOT CfTY T'[L. NO.
US[
BUILDOFING■ DISTRICT NO. GROUP YAP [S BID[Y
■K PG
CONTRACTOR
ADDRESS fff� CONNECTION DATA
STATE DEPTH
CITY TTL NO.
H STATE MANHOLE R[F[R£N UPPER }
REGISTRATION No. COUNTY LOWER
NO. DESCRIPTION OF WORK FEE T r-K OF CONNECTION Row
HOUSE SEWER CONNECTING TO Y. CURB P.L.
PUBLIC S[W[R SB.00 -
PNO.
■ PTIC TANK.S[EPA [FIT OR JOBOB NO.
FITS AND/ORR
DAINFI EID � ♦10.00 CO.IMP.NO.
H OUB[SEWER CONNECTING TO N AD PERMIT NO.
PRI VAT;DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL SLOG.OR VI • RSC RD.INSTR.NO.
WORK TO PIOUS[SEWER 0 8
3.00
OVERFLOW SEEPAGE PIT,DRAINFI[LD
E[TN..C[SSPOOL.DRYWILLMAIIHOL[0 SB.00
AIR N HOU■ HWY.OR ST.WIDENING
SSW[R OR DISPOSAL SYSTEM /7.o0 STAT;[NCROACHMWT
PERMIT NO.
INDUSTRIAL
WAST[FA
CHARGES
OWNF$rS PERMIT s 200
CONNECTION CHARD[FSE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DAT; A CONTRACT WITH THE HEREIN NAMED CON- RKIMNURS[MKNT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED p(ISTINQ DWILLINO
TO THE PUSLIC S[WIR. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF —19—
OWN E
D_OWNER OR NEW HOUSE SEWER
OWNERS AO[NT CONNECT ADDITIONAL
ADDRESS ■UILDING OR WORK
S[FTIC TANK.SEEP,PIT(S)
1 R
HEESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL.ICATI ON AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMELY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING
E
PLUMBING AND ■EWRS. CESSPOOL ❑ DRYWELL ❑
I HEKISY CERTIFRE
Y THAT I AM PROPERLY REGISTERED AND/OR ALTER. PAIR.SEWER OR
LICENSED AS REQUIRED SY LOS ANGLES COUNTY AND STAT[ OF SEWAGE D15POBAL SYSTEM
A
CALIFORNIA OR THAT I M THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A[OV[ DESCRIBED RESIDENTIAL PROF[ ABANDON HOUSE B[W[R
1
SIGNATURE ❑
OF F[RMITT;[ MCKIC TANKS
..,,..FILL(SS) CESSPOOLS
14
VALIDA'fIOROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
9934t3 _IV101 0 D Q
°
�eA6Ae -0' APPLICATION FOR PERMIT
i ,
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DI'TAHTMENT OF COUNTY ENGINEER
B=ING AND SAFETY DIVISION ■U I LDIN13
JOHN A. Ll13MM Co=ty En SSE ADDRESS C
F VIMLL)LK A. IENIEf, Sup'4 of Bunmmq t
LOCALfTY
NUR[ST �
FOR APPLICANT TO FILL INLKOAL
D ESC RIPTIOf1 LOT NO.IdF, 1?t9 OW NE
MAIL
BLOCK TRACT ADDRESS Cr
NO. OF ■LDOS. G d
SIZE OF LOT IL
0 NOW ON LOT / CI TNO. o
U■ OF
BUILDINGS 'C ^I� DISTRICT . GROUP MAr "OC[91S[D SY
J (�■K PO
CONTRACTOR V/ O� V �O L,r��V
ADDRISI p' 06 - CONNECTION DATA
p_L STATION DEPTH
CITY �/ T.L. NO. V
�J �O AT[ MANHOLE REFERENCE UPPQt
REGISTRATION NO. Q �+ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE TYPI OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L TO r.L
PUSLICS[W[R •5.00 P.4 NO.
SEPTIC TANK,S PAG[PIT OR JOS NO.
PITS AHD/OR DRAIHFI[LD 0 SIO.Oo CO.IMP
HOUSE SEWERUR CONNECTING TO TK P RMXrl 7�!/ ROAD PERMIT NO.
PRIVATE [5.
DISPOSAL SYSTEM 0 00 ix
CONNECT ADDITIONAL■LDG.OR -AFFIDAVIT •AIl L,I ulnluT RECORD.1119111.NO. DATE O
WORK TO HOUSE SEWER 0 $3.00 r
OVERFLOW S[[Pg0[PIT.DRAINFIELD �WJ
[XTN..CES91r OOL,DRYWELL,MANHOLE* $8.00
ALTER.R AI O A US HWY.OR ST.WIDENING
■EWER OR DISP04AL SYSTEM 9.00 STAT[ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
����+p� WAST[APPROVAL
Onl\L.LLS PEBbUT s Y OO CHARGES
CONNECTION CHARD[F[E
AUTHORIZATION TorAL FEE
'1 HAVE AY THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. RIIMB(JRS[MENT FEI
TRACTOR TO CONNECT THE ABOVE D[91CRIBED [^ISTINO DWILLINO
TO THE rUBLIC SEWER. APPROVALS DATE INSPECTOR'S BIGNATUR[
SIGNED THIS DAY OF
OWNER OR NEW HOUSE BEW[R
OWNERS AGENT
CONN[CT ADDITIONAL
ADDRESS ■U ILOI NO OR WORK b
SEPTIC TANK,59".PIT(a)
1 H[R[BY ACKNOWUEDO[ THAT I HAVE READ THIS APPLICATION AND/OR DRAIHFIELD
AND STAT[ THAT THEABOVE IS CORRECT AND AGR[[ TO COMPLY
T
WITH ALL COUNY ORDINANCES AND STAT[ LAWS REGULATINO
rLUMBIHO AND SEWERS. CESSPOOL ❑ DRYW[LL ❑
I HERBY CERTIFY THAT I AM PROPERLY REGI aT[RED AND/OR AL7R,REPAIR,SEWER OR
LIC ENS[D AS REQUIRED BY LOS A110LES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM T LiOAL OW H[ AND INTEND TO DISCONNECT PLUG AND
REDID[ IN, TH[ A" B[D,.,f1UID Q1 rA OPE RTY. ASANL�ON HOUSE SEWER
SIGNATURE /-
OF PERMI ❑
BACKFILL■[ IC TAN"S.S
t[[P,PIT(S) CWPDOLS
VALIDATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CI(. M.O. CATH
LAGO1382�3 x-1610 0 5.00- V
i
EatSfl r wt ST /-g .3.*
T'�� pL�
1-d-t *k v 01I, cl 1 rt s
CKSOS10-
74A64lo APPLICATION FOR PERMIT Y
T{AS4 COUNTY OF LOS ANGELES
DEP TINT OF COUNTY ENGII�iH SEWER—SEWAGE DISPOSAL
B ING AND SAFETY DIVISION SUILDING
O A, f XMUF ADPR.
A IFI�EN, e,�'I of Bmlldbiq
LOCAL TTY
M[A R[ST
FOR CANT TO FILL IN ROSS 'T
OAL
DESC111PTION LOT H*ffOWNER
MAIL
K T% ADDRESS
NO. OF BLDOS.
•ru OF LOTojq HOW OH LOT CITY No.
BUILDINGS
OF ojqDISTR)CT N GROUP MAF PROCES BY
■UILDINGS
DK PG
CONTRACTOR b O '53 1
O
ADDRESS CONNECTION ATA
CITY TTL NO. 9TATIOH DQTFi /
■TATS MANHOLE REFERENCE
R[OIST RATION NO. COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CONNXCTIO LENGTH ow
-l'.0 ., h
HOUSE SEWER CONNECTING TO O O Y. CURD .L M.L TO P.L
PUBLIC{EWER 4 68.00 N—ol Ix
NO
• PTIC TANK.■ OR OR 'O■No.
PITS AHD/OR DRAINFI IILD 61p,pp CO.IMP.NO.
HOUSE BEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIE
VATE DIBPOSAL SYSTEM 63.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT VU"m I 1A.0IET RECORD.INS".NT DATE
WORK TO HOUSE■EWER 61.00
OVERFLOW SEEPAGE PIT,DRAINFI[LD — i
EXTN.,CES9ro OL,DRYWILLwANHOLE 65.00
ALTtR.RJIPAIRABANDON WoUnif HWY.OR ST.W I DEN I NO
EER
SWOR P
DISOSAL SYSTEM 63.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
' CHARGES
Q�S I� S 2 OD CONNECTION CHARD[FIE
AUTHORTLATION TOTAL FEE as
I HAVE AT THIS DATE A CONTRACT WITH THE HBREIN NAMtD CON- REIMBURSEMENT FE[
TRACTOR TO CONNECT THI ABOVE D[SCRIem LXI{TINO DWELLING
TO TH[ PUSLIC SEWER. AMOVAIS FAT INSPECTOR'S 81,0rTy RE
SIGNED THIS DAY OF 18_ I�
'ER OR NEW HOUSE
OWNER■AGE CONNECT—C-"7L- CONNECT ADDITIONAL
ADDRES{ WILDING OR WORK
SEPTIC TANK.SEEP,PTT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPI_IUTION AND/OR DRAINFIELD
AHD STATE THAT TH[ A60V[ IB CORRECT AHD AOR[[ TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS RE.UL"NO CESSPOOL ❑ DRYWILL ❑
PLUMBING AND t[WERS.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.BOWER OR
LICENSED AS R[OUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL.SYSTEM ,
LIFORNIA OR THAT I AM THE LEGAL OWNER OF, AHD INTEND TO
RESIDE IN, THE ABO VI DESCRIBED RESIDENTIAL PROPERTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
910 NATU RE BACKFILL SEPTIC TANK/ ❑
LS
OF PERMITTEELA
VAMATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH_
�2 1� MM22 1 a o 7.00- 4