HomeMy Public PortalAbout5825 HART AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING ARID SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS ,\
FOR APPLICANT TO FILL IN LOCALITY ( �^ ,
BUILDING NEAREST
ADDRESS rJ 4'J �I. I CROSS ST.
LOCALITY DISTRICT NO. 'SERIAL NO. PERMIT NO. c
NEAREST �� A �.�LJ �J
CROSS ST. (fes
RECEIVED BY Ready for Inspection DATE I SUED
OWNER �il�✓!il�� li' �®
MAIL USEZONE OCCUPANCY ` BK MAP PG
ADDRESS J 5 ,�
CITY TEL.NO. Q 111
CONTRACTOR e� �_ l� CO.IMP.NO.
ADDRESS �"� JOB.N0.
CITY TELAOO. 9V336 TRUNK PERMIT NO.
SATE
REGISTRATIO NO. T �COTUNTY ;7
ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. 3 PERMIT NO.
BLOCK TRACT �� y[JS' INDUSTRIAL
APPROVAL
SIZE OF LOT�D NOW ON NO.
CHARGES /
USE OF
BUILDINGS CONNECTION CH ABC
z
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
4PUBLIC SEWER X'0S 3.50 ,3 � RECEIPT N0. OATE-ate I BY
— HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR I +�'�EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 , CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 I STATION ® 71 DEPTH �p
SPECIALCONDITIONS ONLY 2.00AREFERENCE
Q, Q LOWER
TYPE OF gl1•fd€CTION LENGTH FROM
l URS M.L.TO P.L. Lr�
OWNERS PERMIT $ I 1 00
AUTHORIZATION I TOTAL FEE
CONAED NTRACTOR TO CONNECT THE ABOVE D SCRIBED(EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_------------------DAY OF........ NEW HOUSE SEWER /J
OWNER OR CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT...
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----•- •-------•-----------•- -
SEPTIC TANKSEEP.
ADDRESS...-_-. rr�x ....`-� �#�t.y,l� ___._../__..-_ ,-._-. AND/ORDRAINF ELD PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL 1:1CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER n
AICD STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED REPDE-WTIA5 PROPERTY. BACKFILL SEPTIC TANKS �Z
SIGNATURE t✓ �'�' SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE---_.
76AG42D 663 1/53 r
TIlDIP-1E CITY
CE606
76A642
0 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FSS'�
_
JOHN A. LANIME, County Engineer b2 1�I o Hc^�•rt Aire,
COLE4IAN W. JENKINS,Sup't. of Building
f'1FOR APPLICANT TO FILL IN
LEGAL Joe D'''r 4 nn
DESCRIPTION LOT NO, OWNER C„j1yv
MAIL
BLOCK TRACT ADDRESS 82:5 N. Hart Avo o
NO. OF SLOGS. /`�
SIZE OF LOT NOW ON LOT 2 CITY T(�miDlo C 1•t"�) TEL. NO.
USE OF a ,. ,..
BUILDINGS Res. and Gra DISTRICT NO. GROUP MAP PRO�dE
SY
I �.+- BK PG /'
CONTRACTOR Square. Do< 1 Sower Sor•vico °�_7+ 'a/j/_ "•`� CC �i
ADDRESS 2933 Maxson Rd. CONNECTION DATA
CITY I
L'11 I�,1ohte TEL. NO. ZI -2020 STATION DEPTH
LICENSE ,� LICENSE UPPER
N0. 12887
0 CLASS 0.,.�2 MANHOLE REFERENCE
LOWER
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 C' $ 5.00 >_
SEPTIC TANK, SEEPAGE PIT OR P.C.NO. D_
PITS AND/OR DRAINF I ELD @ $10.00 CO.IMP. NO. JOB NO. `O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V
PRIVATE DISPOSAL SYSTEM C' $ 3.00
CONNECT ADDITIONAL AFFIDAVIT WAIVER Eq SEMENT RECORD. INSTR.NO. DATE O
1 WORK TO HOUSE SEWER $ 3.00
-A--T-ER, REPAIR OR ABANDON HOUSE 00 (J
SEWER OR DISPOSAL SYSTEM C $ 3.00 W
V F-C-OSE-EP T, - HWY.OR ST.WIDENING d
N
EXTN.,CESS POOL, MANHOLE $ 5.00 STATE ENCROACHMENT -y
I PERCOLATION TEST C $ 5.00 PERMIT NO.
INDUSTRIAL -
T WASTE APPROVAL
CHARGES
WNERIS PERMIT 2 00
rAUfHORIZATION TOTAL CONNECTION CHARGE FEE
E �VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TOR 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
BUILDING OR WORK ,
ADDRESS
SEPTIC TANK.SEEP,PIT(S)
I 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
L,' RESIE
AND SEWERS. CESSPOOL ❑ DRYWELL Cl
CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
A OR THAT I AM THE LEGAL OWNER F, AND INTEND TO DISCONNECT PLUG AND
THE ABOVE DESCRIBED RESIDEN AL P OPERTY. ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS ❑ITTEE
SEEP.PIT(S) ❑ CESSPOOLS ❑
CALIDATION
✓K. M.O. CASH
LAL09 8 1 2G JUL26 1 0 D 5.00M