HomeMy Public PortalAbout10240 GREEN ST_Sewer__ CT° ;o°' APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE- DISPOSAL u
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETI,, DIVISION BUILD11IG 0
JOHN A. LAMBIE, COUNTY ENOiNC6R ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILD(NG
LOCA L fTY-
Ji EA R[rr
FOR APPLICANT TO FIII IN- CROSS °T
I-EdAL 1-1
DESCRIPTION LOT
RH OWH R
MAIL
BLOCK TA #t/ ~ V. AD DREBS
VNO. OF ■LOOS.
SIZE OF LOT NOW ON LOT CItY TIL. NO.
OF
SUI DIfTR IQ O. GROUP M" PR [/BED SY
SUI _
■K PG
CONTRACTOn �v J[
ADDRw (J C,OM4ECTION DATA
CITY TIL. NO. STA-CI ON
6TATI LIC
LICE /[ H ll� QLM■ UP
MIANHOI,K REFERENCE LOWER
N '
No. DZfFRrPTMN OF WORKFYI TYPa OF CONNECTIQN GTN FROM
HOUBE BIEWE0 CONNECTING TO Y. CURA P.L bf.L.Yo P.L. Q
PUBLIC/EWER 98.06
OKI-TIC TANK( ■[ PAGE PIT OR CO.PMP_NO. JOS O. II O
FITS AND/OR DRAINF�ILD S10.DO
HOUR[/EWER CONNECTING TO TRUNK PERMIT NO. ROAD PERYfT NO.
PRIVATE OIBPOBAL SYfT[M 93.00 0
CONNECT ADDITIONAL BLDG.OR, AFFIDAVI fill[[ iAln[I17 RECORD.I—,NO, DATE
WORK TO HOUSE B[WER f3.00
OVERFLOW BEEPAG[PIT.DRAINFI[LD d
E%TN..CISSPOOL.DRYWILL.MAN NOL[ 98.00
AL R,n AIR OR ASANDON OUS HWY.OR fT,%WDIN ENO- N
■[W[R OR OI■POMC SYf'llil 3.DO STATE[NCROACHM[NT
"MIT NO. f
INDUBTR AL
WAST[APPROVAL
cHAnQ[/
o .s.} PERI�T s k- 00
CONNECTION(HARD[
AUTHORIZATION TOTAL �. -7RD[FII
I HAVE AT THIS DATE A CONTRACT WITH T1-1[ H[n[IN NAMED GQH-
REIMBURSEMENT FEZ
TRACTOR TO CONNECT THE AXOV[
ND IA[D
TO Ti PU/LIC • [R /'r EOVAIS D T[ INIl[CTO OHATU RE
SIGNED THIS DAY O �18
OWNER OR NEW HOUSE/EWER
OWN[RB AGE CONNECT ADDITIONAL
ADDRESS Xt=
BU—,NO OR WORK
f[FTSE TANK.SEEP,PIT(/)
I HEREBY AC OW LED AT 1 HAVE RUQ THIN A LIGATION AND/OR DRAINPIR4D
AND CTAT[ THAT THE ABOVE IB CORRECT AND AOn[ Y K TO COMPL
WITHALL COUNTY ORDINANCES• AND STAT[ LAW/ REGULATING
FLU M BIND AND SIWKRS. C[Sf POOL ElDRYWYLL El'
IHCR[SY CERTIFY THAT I AM ROFIRLY R[GIfT[R[D AND/OR` ALTKK REPAIR.BEW[R OR
LICENf[DAS R[OUIR L ANGLES COUNTY AND STATE OF SlFWAG[DISPOSAL SYSTEM
CALIP.,t"A OR THA T At, OWNKh OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A [ ZED nu IDENTIAL PROPERTY. ABANDON HOUSE SEWER
L91GNATU RE '- '
OF P UR BACKFILL SEPTIC TANKS ❑
SEEP.Pff(f) ❑ CKSSPOOLW
AMATION JACK'14. ALLEN
Y.Cl- CASH SUPERVISING MECHANICAL ENGINEFA
CK.
R
ma ryawn.�■
APPLICATION FOR PERMIT 1
■a
DIVISION OF BUILDING AND SAFETY SrWER—SEWAGE DISPOSAL
D"—tn.at o3 C--t7 Enginm ,
County o1 Lo. Angel" FMA
DING �{
JOHN A-LAMBIE, COUNTY ENGINRER ('
It CAS•GATr D. GRIFFIN, HUrT of BumDIHO Lin
FOR APPLICANT TO FELL IN m ST.
LEGAL " �� O
DESCRIPTION LOT N0.
BLOCK TRACT TAIL OF
ADDRESS
NO.OF BLDGS. CITY TEL.
NO.
SIZE F LOT NOW ON LOT
USor
BU`LDINGS yQ DISTRICT GROUP YAP
T BK PG
CONTRACTOR d0ow
ADDRESS COHNEGTION Dara
STATION -" DEPTH
'CITY L. NO. MANHOLE RIFE1U1iCE UPPER
LOWER
REGISTRATION NQ. /3 COUNTY '
N0. DESCPJ TION OP WORK FEE .
HOUSE SEWER COXNFrCTIXG TO TYPE OF CONNECTION LYAQTH FROM
Y.- CURB P.L. Y.L.TO P.L.
PUBLIC SERER 3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 5.00 '00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
i
EXTH.,CESSPOOL,DRYWELL MANHOLE S 2.00 CO. IMP. N0. JOB NO. '
i HOUSE SERER CONNECTING TO �j
PRIVATE DISPOSAL SYSTEM S 1.00 (f TRUNK PERMIT N0. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
i
WORK TO HOUSE SEWER S 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
Off,$ PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIYBUytRSEERENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAYED COX- APPROVALS DATE INSPECTOR'SSIGXATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SERER
SIGNED THIS nAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT fT
EPTIC TANK,SEEP,PIS)
ADDS AND/OR DRAINFIELD 1511,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION . CESSPOOL❑ DRYWELL❑
19
AXD STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY
WLTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SERER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY, OS ANGELI-9COUNTY A
AND STATE OF B"D DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 THE OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT] TY. BACKFILL SEPTIC TANKS❑
BEEP.PIT(s) El CESSPOOLS❑
SIGNATURE `
OF PERMITTEE
JOHN A. LAMr CouNTv NEER VALIDATION ROBERT A.WOOD, CHIRP PL-HG'. INSPECTOR
c>< ■.0. a.-m
21 . 4 T Sm 0 2 .