HomeMy Public PortalAbout6032 HART AVE_Sewer__ e
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42D FOR
APPLICATION OR PERil�i IT
76A642D
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
6032 N. Harb St
WILLIAM A. JENSEN, Sup't of Building rt{ le City
LOCALITY 1
NEAREST
FOR APPLICANT TO FILL IN `ROBS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL ,
BLOCK TRACT 5904 ADDRESS Q
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY / TEL. NO.
USE OF
BUILDINGS DISTRICT O. GROUP MAP - PROC ED BY
�K j PG
o
CONTRACTOR Paul Roberts Inco; i T It- �' &(0
ADDRESS2385 X. Oqks t y^ CONNECTION DATA
CITY TEL. NO. By I !9 p
STATION T/_ ',DEPTH r� �/�
1j{
STATE MANHOLE REFERENCE r+ O
REGISTRATION NO. 211781 C42COUNTY ! s LOWE
NO. DESCRIPTION OF WORK FEE TYPE ONNECTION ` LENGTH FROM q..9
HOUSE SEWER CONNECTING TO Y RB P.L. M.L.TO P.L.
PUBLIC SEWER @ $5.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO,JOB
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. .108 NO. ////����
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N //fyyyy
O
PRIVATE DISPOSAL SYSTEM @ $3.00 /
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER I EASEMENT RECORD. INSTR.NO. DA E
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD g�
EXTN..CESSPOOL,DRYWELL,MANHOLE @ $5.00 HWY. OR ST.WIDENING b
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOS L STEM @ $3.00 STATE ENCROACH T
PERMIT NO.
INDUSTRIAL
WASTE APPRO
OWNERS PERMIT s i 00 CHARGES
AUTHORIZATION I TOTAL FEE I gSl070 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 SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE'SEW ER.,
OWNERS AGENT_ V i
CONNECT ADDIT I'O NAL � � �/� ✓f
ADDRESS BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(5) r
1 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 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 THA AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. T&EA VE ESCRIBE RES DfrNTIAL PROPERTY.
/� -/ ABANDON HOUSE SEWER
SIGNATURE /J < BACKFILL SEPTIC TANKS ❑
y Y ({
OF PE R1.11'�'G SEEP.PIT(5) ❑ CESSPOOLS ❑
ALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
Lp
iO 8' 7 5 6 E AUG 9 1 1 D 25-00-
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Temple City
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CESO
3-62
APPLICATION FOR PERMIT
76A642D U
COUNTY OF LOSANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu'LD NG
JOHN A. LAMBIE, County Engineer ADDRESS
A032 &, Hart
SS
A. JENSEN, Sup't of Building C
'. LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. pareel R of
l± 3 OWNER S Brigham
MAIL
BLOCK TRACTADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY T/ TEL. NO.
DDISTRTy ICT N.,. ....-_ ..... O
USE OF
BUILDINGS O. GROUP - MAP PROCESSED BY
CONTRACTOR
Paul Roberts Inc 6Pi
ADDRESS 2185 N Fair Oaks Avenue CONNE¢�TION DAT.A.�
CITY Altadena TEL. NO. Sy 4=4472 STATIONq:j fEj DEPTHTATE
I /O
REGISTRATION NO. � 231781 C42 COUNTY MANHOLE REFERENCE �I1 " / LOWER
No. DESCRIPTION OF WORK FEE E OF COIN TION V LENGTH FROM
O
PUBLIC SEWER HOUSE SEWER CONNECTING TO $5.00 Y. R P.L. V M.L.TO P.L. 106
SEPTIC TANK.SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. V
HOSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT
__PR,VATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EA5ENENT RECORD.INSTR.NO. DAT
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,ORYWELL,MAN HOLE @ $5.00 y
ALTER.REPAIR OR ABANDON HOUSE HWY,OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHENT ~
PERMIT NO. II
INDUSTRIAL
WASTE APP
OVV'NER'S PERMIT $ i 00CHARGES
A
AUTHORIZATION TOTAL FEE V CONNECTION CHARGE FEE
I HAVE 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 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
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT11AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB E DESCRI�SIDENTIAL PROPERTY. � gBANDON HOUSE SEWERSIGNATURErA ./.O`l BACKFILL SEPTIC TANKS ❑
OF PERMIT i..- SEEP,PIT(S) ❑ CESSPOOLS ❑
ALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENGINEER
CK.
LAC9
.75 .AUG' 91 0 D 7.0 Or, It