HomeMy Public PortalAbout10242 GREEN ST_Sewer__ �iy
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7eA/4ED APPLICATION FOR PFRMIT
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COUNTY OF Los ANGELES _ SEWER—SEWAGE DISPOSA LI
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRw B 2
COLEMAN W. JENKINS. SUPT. OR BUILDING
LOCA L STY
NEAREST
FOR APPLICANT TO FILL IN 7 DRO&S ST.
LEGAL
DESCRIPTION LOT NO. OWNER IL
HAIL 71
BLOCK T ADDR ESf
NO. OF BLOOM.
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OF DISTRICT NO. GROUP MAP- ROCESS[D SY
■U ILDING■
■K ro
CONTRACTOR �J�
ADDRK" CONNECTION DATA
-- STATION DEPTH
CITY TEL. NO
s-rA LIC MANHOLE R�GfINC[ /'^� l
LICENSE NOi CL V/ LOWER
NO. DE9CRi?vTIOf4 OF WORK FEE TYPE DIV COHN[CTIO L OTH FR
HOUSE B[WER CONNECTING TO �y�► Y. CURB r P.L M.L-TO P. OM e
L (•J 4.
PUBLIC/EWER 49 SB.DO W O
SEPTIC A ,■ P O[P OR Y-
PITB AND/OR 1)RAINFI ELD /10.00 CO.IMP.NO. \ V
GUER
S[/ WECONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRI VAT[DISPOSAL SYSTEM 59.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAWT ■V►R Ll►S[YY RECORD.I .NO. DATE
WORK TO HOUSE SEWER $7.00
OVERFLOW SEEPAGE PIT.DRAINFI[LD
d
[XTN.,C[B■POOL.DRYW[LL MANHOLE 5B.00 N
ALTER.R AIR O ABANDON O HWY.OR ST.WIDENING Z
-
SEWER
OR DISPOSAL SYSTEM 59.00 STATE ENCROACHM[HT
PERMIT NO.
INDUSTRIAL
WAIT[APPROVAL
OV NERDS PERMIT : z CIO
'CON RECTION CHARD!F[[ CHARGES
AMOF=!rION TOTAL FEE Z
IHAV[ AT THIS DATE A CONTRACT WITH THE HEREIN NAMXD CON- R[IMST URSEMENFE[
TRACTOR TO CONNECT THE ABOVE p[SCRIB[D
TO THE PUBLIC S[W[R. _ - A.PPROVAIS A INSP[CTO R'SS t1ATU R[
SIGNED THIS Y F A
OWNER OR N[W HOUSE SEWER
OW N[Kill ACOP[NT CONNECT ADDITIONAL
BUILDING OR WORK.
ADDRESS SEPTIC TANK.JIK",PIT(S)
I H[A BY K L OE I R THIS APPLICATION AND/bR DRAINFIELD
AND STAT[ THAT TH[ ASq S CORR[Ci AND AGREE TO COMPLY
WITH ALL COUNTY ORDI ES AND STATE LAWS REGULATING
PLUM SING AND SEW ERI. CXASPQOL ❑ DRYW[LL ❑
I HERESY CERTIFY THA �pl.oLPKRLCYoRZGISTlRXD AHD/OR ALTER.REPAIR./EWER OR
LICENSED AS R[OUIR ISUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT L OWNEROF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IH, THE A ESIDENTIAL PROPERTY. ABANDON HOUSE 21 WKR
SIGNATURE ❑
OF PERM BACKFILL ANK/
/[IP.PIT(/)
5" IC TC[ISroO
VALIDATION JA K . ALLIKK
M.O. CATH SUPERVISING MECHANICAL ENGINEER
- CK.
75022 DEC 31 0 D 7.Q0 7
kn
so"q f1-a1 APPLICATION FOR PERMIT 1
•i 4�
DrimoN of svII ING AND SAFETY SEWER—SEWAGE DISPOSAL
Dopwh"nt of C--ly Enuhum
C=uy of La. a.. FADDRIE"
DIIIG D
JOHN A. LAMBIE, CouNTY.ENOINEER
BU'
m CASSATrD. ORIFPIN, SUP"rOFtUILDING =
RZARAIST
FOR APPLI T FILL IN CROSS ST.
LEGAL OWN1IA
DESCRIPTION. L 0.
MAl L - .
BLOCK It ADDRESS -
NO.OF BLDG$. CITY TEL, NO.
SIZE OF LOT NOW OR LOT
USE
_BUILDINGS DDISTRICT NO. GRDUP IS"B[ PG
CONTRACTOR / L
ADDRESScomic=oN narA
- - STATION- - DEP H
CITT . 0• 7ANH0LE REFEIIENCE UPPER
ATE LOWER
REGISTRATION N0. ❑ COUNTY
No. DESCRI ION OF RK FEE
FROM
HOUSEa Y
ER CONNECTING TO. TYPE O� CONNECTION M.L.LENTO
Y. CURB P.L. Y.L.TO P.L..L.
PUBLIC SEWER 3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.00 L�
OMFLOW SEEPAGE PIT,D AINFIELD P. C.INO•
i
KXTX ,CESSPOOL,DRYWELL YAMHOLE 0 $2.00 CO. IVP. NO. JOB NO.
i HOUSE SEINER CONNECTING TO �7
i PRIVATE DISPOSAL SYSTEM ® S 1.00 LJ TRUNK PERMIT NO. ROAD.PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER S 1.00
PERMIT X0.
ALTER,REPAIR OR ABANDON HOUSE
$EWER OR.DISPO$AL SYSTEM 11.0-0 INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
ovnmlS PE UM S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEkFT _
1 HAVE AT TH76 DATE A CONTRACT WITH THE HEREIN WANED CON- '
APPfiOVJ�LS DATE IN9PECTOR'ESI ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - NEW HOUSE SE1tER
SIGNED THIS WAY OF 19 CONNECT ADDITIONAL
OWNER OR .BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(SJ
ASSESS
AND/OR DRAINFIE D'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CE99POOL❑ DRYWALL❑
AND STATE THAT THE AIIOVE 19 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE. LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PR gLY REGISTERED AND/OR DISCONNECT�LUC AND
LICENSED AS REQUIRED 0 A ES COUNTY AND STATE OF AB DOM HOUSE SEWER
CALIFORNIA OR THAT A Ef LE GOR F THE ABOVE
DESCRIBED RESIDEN P P BACKFILL
LSEEP.PIT SSEPTIC CN TANKS El 0$19"TURE �.
OF ERYITTEB - '
JOHN A. LAVE. COUNTY EER VALIDATION ROBERT A. WOOD, CHIEF,PL-BO. INSPECTOR
CL Y.0. CAS�A�pr - .