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Home My Public Portal About10224 GREEN ST_Sewer__ REPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER I BUILDING ADDRESS FOR APPLICANT TO FILLJt4 LOCALITY BUILDING / NEAREST 4_0 W1 ADDRESS Q , I L-0 , CROSS ST, A LOCALITY DISTRICT 0 SERIAL NO. PERMIT NO. NEAREST A /Z �q, CROSS ST. RECEIVED)3Y Ready for Inspection DATEISSUED OWNER 1 J, /y`, ( MAIL USE ZONE OCCUPANCYBK MAP PG ADDRESS ,mss _- � CITYi,=��¢A, �T� NO. CONTRACTORf CO.IMP.NO. ADDRESS �J f'� C/yM1-! r.. aC'CL- IX JOB.N 5' CITY` TELAO. TRUNK PERM STATE REGISTRATION N0. ? 8 COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. �� STAMIT NOROACHI*t`NT Ly,� BLOCK TRACT(/,E Q / �G,.. 4e.e INDUSTRIAk L,I=- q WASTE AJ•PROVAL _ SIZE OF LOT �ak,3 NOW ON LO s J TS CHARGES ``•.0 USE OF BUILDINGS CO CTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSENT FEE HOUSE SEWER CONNECTING TO PUBLICSEWER @ $ 3.50 RECEIPT DATE / HOUSE SEWER CONNECTING TO ) /1 PRIVATE DISPOSAL SYSTEM 1.00 • VOZ CONNECT ADDITIONAL BLDG.OR EkIDEPTION RE ED WORK TO HOUSE SEWER 1.00 NO. ALTER OR REPAIR EXISTING TE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 C NECTION D A SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 7 STATION DEPtv CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLEREFERENCEEFERENCE _ LOWER TYP F CONNECTION LENGTH FROM OWNERS PERMIT $ I 1 00 Y. CURB P.L. M.L.TO P.L. AUTHORIZATION I TOTAL FEE I U. 1216 IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS-------------------DAY OF...._......_ _ _.•_•.--.19__-_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT............. BUILDING OR WORK SEPTIC TANK,SEEP.PIT(3) ADDRESS--_---•-----------•---•-•--------------_--------------------••-------------------- AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL � j CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE l TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND DISCONNECT ABANDON HOPLUG PLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOV ESCRIBED RE OENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]r* ..� SIGNATURE ✓/f SEEP.PIT(S)� CESSPOOLS OFPERMITTEE-. ''" . ---/ 7 76A642A 663 7/53 75-65 6A6420 APPLICATION FOR PERMIT 76A 64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A.LAMBIE,County Engineer ADDRESS jzA•� j� S' COLEMAN W. JENKINS,Sup't.of Building ^� LOCALITY NEAREST FOR APPLICANT TO FILL IN CRDSS BT. R LEGAL DESCRIPTION LOT N ,` OWNER MAIL _ BLOCK TRACT ADDRESS 9(5_ NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY rxA TEL. NO. USE OF s DISTRICT NO. G MAP PROCESSED BY BUILDINGS Lo CONTRACTOR A r � n J • d 1 ;-1 .5 G� ; ADDRESS d.,^ lv [��-- V L2 -CONNECTION CJ^DATA `� CITY_9jQy(f �r ; TEL. NO. / p�Q ION S t DEPTH LICENSE LICENSE NO. MANHOLE REFERENCE CLASS C LOWER NO. DESCRIPTION OF WORK FEE TYPE OFC N _�/ LENGTH F OM D HOUSE SEWER CONNECTING TO Y. ,.mac. M.L.TOP. PUBLIC SEWER ^ $ 5.00 EPTIC TANK, SEEPAGE PIT OR P.G.NO. d PITS AND/OR DRAINFIELD - C $10.00 CO.IMP.NO. Wks-pis, (1 O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD M Nd. U PRIVATE DISPOSAL SYSTEM $ 3.00 C9 CONNECT ADDITIONAL BLDG. OR AFFIDAVIT WAIVER EASEMENT RECORD.t STIR.NO. DATE O WORK TO HOUSE SEWER - $ 3.00 REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM $ 3.00 W H WY.OR ST.WIDENING d EXTN.,CESSPOOL, MANHOLEto$ 5.00 STATE ENCROACHMENT Z PERCOLATION TEST C $ 5.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERCHARGES S PERMIT $ 2 0o E AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE a , ` IAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TR CTO TO CONNECT THE ABOVE DESCRIBED E (STING OW 1-11N ADDRESS G TO THE PUBLIC ER. APPROVALS DATE INSPE 'CTORAT,URE SIGNED THIS DAY OF 1 47 OWNER OR /i , NEW HOUSE SEWER /! OWNERS AGE (�/ • CONNECT ADDITIONAL BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AN INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO ESCRIBED RESIDENTIAL P ERTY. ABANDON HOUSE SEWER _ SIGNATURE OF PERMITTEE11G BACKFILL SEPTIC TANKS xSEEP.PIT(S) [I CESSPOOLS �� t LIDATION q/ CK. M.0. CASH A;O 1 O 4 5`10- OCT 5 8 D 8 G.C.I 0 ` 1046a u�T 51 D 7.00 CESOB 5-65 76A 642D APPLICATION FOR PERMI COUNTY OF LOS ANGELES SEWER-SEWAGE DIS OSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING lea L JOHN A.LAMBIE,County Engineer ADDRESSp19Y COLEMAN W. JENKINS,Sup't. of BuildingLOCA LiTYNEARESTFOR APPLICANT TO L IN CROSS s7. ;LEGALDESCRIPTION LOT NO. OWNERMAILBLOCK TRACT ADDRESS Pe SIZE OF LOT NOWOON LOTS CITY ' �/ TEL. NO.USE OFDISTRICT NO. GROU MAP PROC BUILDINGS .(�/� BK PG CONTRACTOR ,/ Jw L dl ADDRESS CONNECTION DATA ION I ,DEPTH CITY 4 TEL. NO. e,. , LICENSELICENSE N0. T CLASS MANHOLE REFER LOWER NO. DESCRIPTION OF WORK FEE YPE OFC OLENGTH F M HOUSE SEWER CONNECTING TO L. M.L.TO P.L. PUBLIC SEWER $ 5.00 �- SEPTIC TANK, SEEPAGE PIT OR P.C.NO. d PITS AND/OR DRAINFIELD $10.00 CO.IMP.NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PER T AO U PRIVATE DISPOSAL SYSTEM '-'' $ 3.00 w CONNECT ADDITIONAL BLDG. OR AFFIDAVIT WAIVER EASEMENT RECORD.IN R.NO. DATE O WORK TO HOUSE SEWER ?- $ 3.00 F- 'ALTER, REPAIR OR ABANDON HOUSE U SEWER OR DISPOSAL SYSTEM = $ 3.00 W OVERuRWINFIELD HWY.OR ST.WIDENING Q- N EXTN.,CESS SEPOOL, MANHEPAGE OLE $ 5.00 STATE ENCROACHMENT Z PERCOLATION TEST C' $ 5.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT $ CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE L 6v 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) 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 ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO SCRIBED RESID NTIAL ROPE RTY. ABANDON HOUSE SEWER SIGNATURE CBACKFILL SEPTIC TANKS ❑ OF PERMITTE ❑ SEEP.PIT(S) ❑ CESSPOOLS VALIDATION----) CK. M.0,O. CASH LJLO IQ 4 7:� ocr 5 1 1 D 2 5.00—