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Home My Public Portal About10246 GREEN ST_Sewer__ CEBOS -62 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING { JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ` O COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY NEAREST FOR APPLICANT O FILL IN CROSS SA. LEGAL DESCRIPTIONLOT NO. OWNER MAI BLOCK TRACTmf— AD SS O. OF BLDGS. SIZE OF LOT NOW ON LOT CITY EL. NO. USE OF DIST GT NO. ROU PMAP PROCESSED BY BUILDINGS // BK (PG+ < CONTRALTO ADDRESS O 1 '' CONNECTION DATA STATION `�.IL/y Ar,� DEPTH ,S�� CITY ® TEL. NO. � T[`--' /� UPPER LICENSE NO. ® CLA55 L.r� MANHOLE REFERENCE !-� LOWE NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION V LEN H FROM HOUSE SEWER CONNECTING TO ` Y. CURB P.L a PUBLIC SEWER $5.00 ADZ% 0 SEPTIC TANK,SEEPAGE PIT OR JOB NO. 7J ` U PITS AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. ix PRIVATE DISPOSAL SYSTEM $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEM[!IT RECORD. INSTR.NO, DATE F- WORK TO HOUSE SEWER @ $3.00 (,J OVERFLOW SEEPAGE PIT,DRAINFIELD L1J EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 O) N HWY. OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE Z SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT i 2 00 CHARGES AUTHORIZATION TOTAL FEE -y e,1-c CONNECTION CHARGE FEE 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'S�.SI.G NATURE SIGNED THIS DAY OF 19_ f OWNER OR AST/ NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS I 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 ❑ I HEREBY CERTIFY TH I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSEDAS REQUIRE S ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A DE RIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER 1 SIGNATURE PER MTTTEE BACKFILL SEPTIC TANKS ❑ y OF .,/S - SEEP. PIT(S) [ICESSPOOLj � VALIDATION JACKR: ALLEN SUPERVISING MECHANICAL ENGINEER 0. M.O. CASH LFA 7 5 0 4 DEC 3 1 4 D 7.0 0 �` D S&E-683 tI.53 APPLICATION FOR PERMIT 1 3&E-8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADpRESS ® CASSATT D. GRIFFIN. SUPT of BUILDING LOCALITYNEAREST is FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO,, OWNERE - 'E- BLOCK TRA MAIL ADDRESS . OF BLDGS. CITY- TEL. NO. SIZE OF LOT NOW ON LOT USE OF // ., DISTRICT GRA MAP BUILDINGS C rLG T I / BK PG CONTRACTO rl,�� L CONNECTION DATA ADDRESS CITY R STATION DEPTH L.NO REFERENCE UPPER Y STATE LOWER REGISTRATION NO -- / ❑ COUNTY NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y_ CURB P.L. M.L. TO P.L. PUBLIC SEWER @ $3.50 SEPTIC TANK,SEEPAGE PIT OR /iJrj PITS AND/OR DRAINFIELD @ $3.00 !!� OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO. I HOUSE SEWER CONNECTING TO 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 SEWER OR DISPOSAL SYSTEM @ $1.00 INDUSTRIAL WASTE APPROVAL CHARGES _ CONNECTION CHARGE FEE OWNER'S PERMIT $ t 00 AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN'NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE 0. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, NEW HOUSE SEWER 010/ 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 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNE�PLUG AND LICENSED AS REQUIRED B 'LOS ANGELE COUNTY AND STATE OF pBANDO, USE SEWER CALIFORNIA OR THAT AM E LE ,b ER OF THE ABOVE DESCRIBED RESIDENTI PR Y. BACKFILL'SEPTIC TANKS❑ SIGNATURE SEEP._PIT(S) ❑ CESSPOOLS❑ OF PERMITTEE JOHN A. LAM E, COUNTY E EER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. M. U. CASH rL; DOa48% APR 21 4 A 5.00 1