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HomeMy Public PortalAbout6245 HART AVE_Sewer__ CEBOB;2-68 " ...APPL�UC/,aU'UON, I OR" PLG�Mo 1 78A 6420 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUIL.-s G' '/,-S JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING J t LOCALITY T— NEAREST c FOR APPLICANT TO FILL IN caoss ST. hOLEGAL f� 1' DESCRIPTION LOT NO. r OWNER �/ MAIL _ 5 U^off- Uf .�� BLOCK TRACT (�/ ADDRESS 1�J e$ an/c (1 SIZE OF LOT NOWOF IILDG ON LOTS CITY J;,,nJ�. ` ( TEL. NO. 5 6 /V V USE OF BUILDINGS DISTRICT NO. GRCULEJ MAP PROCESSED BY IBK PG CONTRACTOR / s f y � "` 6 VADDRE ,j�1jry/�YJ�� 2 CONNECTION. OZ/Q -I`X- TEL. NO. p �J ZI STATION DEPTH 3 C lIC /J/ l CLASSMANHOLE REFERENCE CRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH OM EWER CONNECTING TO Y. CURB P.L. M.L.TO .L. - PUBLIC SEWER $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TOTRUNK PERMIT NO. ROAD PERMIT NO. � PRIVATE DISPOSAL SYSTEM @ $3.00 C) CONNECT ADDITIONAL BLDG.OR --CORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 BANOON HOUSE HWY.OR ST.WIDENING _ U W SEWER SYSTEM @ $3.00 STATE ENCROACHMENT N PERMIT NO. m INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE 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 ALS DATE I NSPECTOR'S SIGNATURE SIGNED THIS DAY OF / 19/7/ OWNER OR //� „/ NEW HOUSE SEWER OWNERS AGECNT, /fY(/ ` /'�✓(-� ADDRESS X7 )6 fY ''�- / z-/v/I 'CJ V'.:-�i�. ,4�. CONNECT ADDITIONAL J BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT 1 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 THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND I RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMff7EE ❑ SEEP.PIT(S) ❑ CESSPOOLS VALIDATION JACK. R. ALLEN M.O. CASH SUPERVISING MECHANICAL ENGINEER C rpr 00041:= hPR29 10 0 5.00 ' CEA OS�}2-08 78A 6420 /r`APPL OCA Y U®N FOR Y ERMLL LL COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL, �. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION NcILD,1�DI JOHN'A. LAMBIE, COUNTY ENGINEER BUeu3 2 „51 1 COLEMAN W. JENKINS, SUPT. OF BUILDING ' LOCALITY Ei j FOR APPLICANT TO FILL IN DESCRGPTION LOT NO. - I ,C�/ •��� OWNER' ©MAIL p' ` a. BLOCK TRACT 115_ 511 U ADDRESS 5 K 1 NO. OF BLDGS. 3 r / SIZE OF LOT Q � NOW ON LOT CITY TEL. NO �j /9 BUILDINGSlye> D`�CT NO. ]TP BKS` C ,PROCESSED BY USE OF MAP CONTRACTOR .Q v' .®✓� I ADDRESS ' S• a 1, JJJ` /// C/yO�NNECTION DATA CITY 14a -f TEL. NO. S '® 77 �'TION '/�ry' % l DEPTH STATE UPPER v LI " MA H L REFERS/NCE! P LICENSE NO. CLASS NO. DESCRIPTION OF WORK FEE L F C NNE .n N LENF GT. ROM HOUSE SEWER CONNECTING TO Y„ U PUBLIC SEWER $5.00 00 ' M.L.TO P.L. SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM M @ $3.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAIVEN EASEMENT RECORD,INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT.DRAINFIELD C EXTN..CESSPOOL.DRY WELL.MANHOLE @ $5.00 HWY. OR ST.WIDENING F— ALTER.REPAIR OR ABANDON HOUSE V SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT d PERMIT NO. - C/) INDUSTRIAL z WASTE APPROVAL OWNERS PERMIT $ z 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE pp I HAVE AT THIS DATE A .CONTRACT WITH THE HEREIN NAMED CON- RE I MBURSEMENT FEE TRACTOR TO-CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �/ TO THE PUBLIC SEWER. APPROVALS ALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19 1 OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 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 IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LE AL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABO E CRI E RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BAC . y KFILL OF TURF TEE /1 � CESSPOOLS i C/J/O/1) VALIDATION JACK R. ALLEN M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. , �f CEA 6422 68 e APPA Q n C Q TB®N, FOR PERM 76A sato II�r IL�U hl J(' IJP( OVII COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT. OF BUILDING /t LOCALITY ♦ (�(� NEAREST ^ FOR APPLICANT TO FELL IN CROSS ST. C! (j LEGAL L ,Q DESCRIPTION LOT NO. =Lj � Uf OWNER- 4 S MAIL BLOCK TRACT , ADDRESS 5 ct ✓� NO. OF BLDGS, SIZE OF LOT NOW ON LOT / CITY '( TEL. NO.. USE OF BUILDINGS DISTRICT NO. GR UP MAP PROCESSED BY {@ CONTRACTOR C /..G /) ADDRESS T/(��wti;ll [�% CONNECTION DATA �j� CITY -g_�fa TEL. NO. ®_C/7 7 `ST/TION v/ 1, DEPTH i( / STATE Q'1\ LIC Z MAH O E REFERENCE , :JL UPPER_ LIC6N SE NO: v �f CLASS q e NO. DESCRIPTION OF WORK FEE TY E F CO ECT LENGT FROM HOUSE SEWER CONNECTING TO Y. �P�9_ �M �y f �q PUBLIC SEWER E5.00 -�j/�,C G U-[t iCE" M.L.TSO P.L. /0 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. , PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. / JOB NO. HOUSE SEWER CONNECTING TO r /9 ^ >_ PRIVATE DISPOSAL SYSTEM @ $3.00 TRUNK PERMIT NO. ROAD PERMIT NO.y' j/ CL CEJ V CD CONNECT ADDITIONAL BLDG.OR AFFIDAVIT AlwYEE EASEMENT RECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 CD OVERFLOW SEEPAGE PIT.DRAINFIELD CD EXTN..CESSPOOL.DRYWELL,MANHOLE @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING IJ W SEWER OR.DISPOS L YSTEM $3.00 STATE ENCROACHMENT D_ 12 /1� PERMIT NO. C/')4C {/ INDUSTRIALrl I r / WASTE APPROVAL OWNERS }� PERMIT S CHARGES AUTHORIZATIO+. TOTAL FEE o o CONNECTION CHARGE FEE 1HAVE 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 ALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF Ig_ 1' OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'SEPTIC TANK.SEEP,PITS) A'NDZOR 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 THAT I AM THE LEGAL O NER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE D IBED f3 S NTIAL PROPERTY. ABANDON HOUSE SEWER OF PERMITTEE P BACKFILL SEPTIC TANKS ❑ SEEP.PITS) ❑ CESSPOOLS ❑ SIGNATURE VALIDATION JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER GK. M.0. CASH !_ ' s X16 1 1 0 2.5.00 W CE808 2470- 76,14 642D ' COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 'DEPARTMENT OF COUNTY ENGINEER n- BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING �^ 1'. LOCALITY C..� FOR APPLICANT TO FILL IN NEAREST CROSS ST (PRINT OR TYPE ONLY) LEGAL DESCRIPTION LOT NO. IV, ` -V / CJ OWNER r MAIL BLOCK TRACT ®� ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT / CITY ` TEL. NO. USE OF DIST R ICTNO. GROUP CLASS MAP PROCESSED BY' BUILDIN SK CONTRACTOR,,4 , Pa ADDRESS CONNECTION DATA CITY 4 //J<f'TEL. N _ STATION STALIC DEPTH LICENSE NO; �7/ v� �(� CLA S - MANHOLE REFERENCE if `/ `. UPS NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH OM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P. . PUBLIC SEWER SEPTIC TANK.SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. .JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d PRIVATE DISPOSAL SYSTEM CEJ $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER "EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ S3.00 V OVERFLOW SEEPAGE PIT.DRAINFIELD Cie EXTN..CESSPOOL,DRYWELL.MANHOLE @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING O SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT t V PERMIT NO. R } a W _ - INDUSTRIAL h WASTE APPROVAL Z CHARGES OWNER'S PERMIT $ 00 , AUTHORIZATION TOTAL FEE ; CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED (C,IO{N/. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING i TO THE,PUBLIC SEWER. APPROVALS DAT SP CTOR'S SIGNATURE SIGNED.THIS /DAY OF 19_ ' OWNER OR is/� NEW HOUSE SEWER I OWNERS AGENT CONNECT ADDITIONAL ' BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION.' SEPTIC TANK.SEEP,PIT(5) AND/OR DRAINFIELD I. 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 AT I PROPERLY RE ST ED AND/OR ALTER, REPAIR,SEWER OR LICENSED AS REOUI D Y, S ANGL OU Y ND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR T I M E LEGA NE OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE V CRIBEO S N A. ROPERTY. ABANDON HOUSE SEWER SIGNATURE I BACKFILL SEPTIC TANKS ❑ OF PERM EE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATIO� / UPERVISJACK R. ALLEN CK. M.O. ING MECHANICAL ENGINEER CAS ACO 2 7 .4 21- uG+ 71 D 6.00- cQ