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Home My Public Portal About10244 GREEN ST_Sewer__ D IS&E-663 11-SB APPLICATION FOR PERMIT 1 8&E•6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITYRIAHIbI FOR APPLICANT TFILL IN CROSS ST. - LEGAL DESCRIPTION- LOT NO. �� o' OWNERoej �f BLOCK TRACT MAILADDRESS NO.OF B S. CITY TEL. NO. SIZE OF LOT NOW ON T USE OF tr DISTRICT NO. GROUP MAP BUILDINGS L. G _. BK PG CONTRACTOR ADDRESS '" - CONNECTION DATA �" STATION DEPTH CITY � ` EL 0. �+ � UPPER MANHOLE REFERENCE f/ '''--yyy''' ( LOWER REGISTRATION NO r O' Z_ . ❑ COUNTY NO. DESC P ON Of WZ5 RK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $3.50 SEPTIC TANK,SEEPAGE PIT OR �p PITS AND/OR DRAINFIELD a $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO. i EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO. i HOUSE SEWER CONNECTING TO s - I PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT - WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 REIMBURSEMENT FEE AUTHORIZATION I TOTAL FEE j" R 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN IFAMED CON- APPROVALS DATE INSPECTOR'S SI GNATURE �. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ 174 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ---_-_._ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY L ANGELES U:NTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I A T EG OW ER OF THE ABOVE — DESCRIBED RESIDE NTIA P P BACKFILL SEPTIC TANKS❑ SIGNATURESEEP. PIT(S) [I CESSPOOLS❑ OF PERMITTEE - R - 4 JOHN A. LAMB1 , COUNTY ENGINEE VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. M.O. CASH ,ZDO 0 4 7r, APR 21 4 A 5.0 0 2 62 76A642D APPLICATION FOR PERMIT 6A6 COUNTY OF LOS ANGELES SEWER—SEWAGE D SPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING I L JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT d ADDRESS NOF SLOGS. 00 SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT GROUP MAP P CESSED BY BUILDINGS � 7BK �j'(P��G� CONTRALTO 6 � Y ADDRESSAf- CONNECTION DATA CITY TEL. NO. STATION 14 6g,37- DEPTH STATE LIC I / ��J LICENSE NO CLASS MANHOLE REFERENCE T LOWER NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION L GTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L LXGT FROM Y. D_ PUBLIC SEWER IS $3.00 v(„� SEPTIC TANK.SEEPAGE PIT OR NO ( / 0 PITS AND/OR DRAINFIELD @ 510.00 CO.IMP.NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ 53.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER I IASIMINT RECORD.INSTR.NO. DATE F" WORK TO HOUSE SEWER 0 $3.00 W OVERFLOW SEEPAGE PIT.DRAINFIELD d EXTN..CESSPOOL.DRYWELL.MANHOLE a 53.00 N ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING Z SEWER OR DISPOSAL SYSTEM @ 53.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERmn $ 2 00 CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE "7 6_Q' IHAVE 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' N IRE SIGNED THIS-DAY OF 19_ OWNER OR / NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 Cl DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED !jv ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 'LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE A D 1 E RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMrrTEEBACKFILL SEPTIC TANKS ❑ t ,-.�"'�'}' SEEP.PITIS) ❑ CESSPOOL$ 4v � '✓ ' VALIDATION JACKIR. ALLEN SUPERVISING MECHANICAL ENGINEER CK�111' M.O. CASH i L 7sv3�S DEC 310 D 7.00~ p i i