The URL can be used to link to this page

Home My Public Portal About6028 HART AVE_Sewer__ -E4 76A6420 APPLICATION PPICPTION FO® PERMI COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't o4 Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS 5T. LEGAL �J DESCRIPTION LOT NO. .J OWNER Il( MAIL BLOCK TRACT (� ADDRESS /� NO. OF SLOGS. SIZE OF LOT L/ ,,NOW O LOT (� CITY `a� k EL. -NO. USE OF - / • DISTRICT NO. GROUP MAP PROC BY BUILDINGS ZL BK P CONTRACTOR ADDRESSf J / CONNECTION DATA G STATION DEPTH CITY �/� ��'� L. NO. d ❑ STATE UPPER MANHOLE REFERENCE REGISTRATION NO. ❑ COUNTY 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 @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. a PITS AND�OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ S3.00 O OVERFLOW SEEPAGE PIT,DRAINFIELD V EXTN..CESSPOOL,DRYWELL,MANHOLE @ $5.00 HWY.OR ST.WIDENING W ABANDON HOUSE d. SEWER SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. c:Z-e 1 INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 21 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESC BED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS ,DAY OFA OWNER ORL.,� �. / NEW HOUSE SEWER OWNERS AGENT Q 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 WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM TH LEGAL OWNER OF, AND INT NO TO DISCONNECT PLUG AND • RESIDE IN, THE ABOV DES IBED RESIDE I L PROPER j. J/ ABANDON HOUSE SEWER SIGNATURE J/ OF PERMITTEE // vj �/ L• BACKFILL SEPTIC TANKS ❑ Y may ' SEEP.PIT(S) ❑ CESSPOOLS - � � .. 7— R BERT k WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. LfHU0 o 9 6 01 SEP 2 9 1 C) D 5.00- 17 76A64 0 q PPILOC p,y ION FOR IpiC'®MrT 76A642D PY P`i 9 u Itl If'( Y-IGIfYIVII COUNTY OF LOS ANGELES SEWER-SEWAGE D1 PO L DEPARTMENT OF COUNTY ENGINEER C BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCAL IT NEAREST FOR APPLICANT TO FILL IN `ROSS ST. 47 LEGAL DESCRIPTION LOT NO. JOWNER MAIL BLOCK TRACT ADD S NO. OF BLDGS. SIZE OF LOT NOW ON LOT / CITY TEL, -NO. USE OF „ DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS11 3� rer CONTRACTO Wv ADDRESS CONNECTION DATA dF CIT TEL. NO. •/ STATION DEPTH REGISTRATION NO. ,� COUNTY MANHOLE REFERENCE e LOWER NO, DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGIV FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TJ6 P.L. PUBLIC SEWER 53.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. } PITS AND/OR DRAINFIELD $10.00 CO.IMP,NO. JOB NO. ND. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIY[11 I 1A11Mt NT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER $3.00 O OVERFLOW SEEPAGE PIT,DRAINFIELD F EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 V ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING d SEWER OR DISPOSAL SYSTEM $3.00N STATE ENCROACHMENT � 4 PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE CARGES IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL -� .ADDRESS BUILDING OR WORK �(!'d-•u", SEPTIC TANK,SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT 1 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 ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPE REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED B ANG S OUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I THE E F. D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOV S TIAL TY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER 0 M.O. CASH