HomeMy Public PortalAbout9839 HOWLAND DR_Sewer__ 8&C-6311.55 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY /
NEAREST
FOR APPLICANT/TO FILL I.LNt, CROSS STLEGA L .
DESCRIPTION LOT NO. �{..'v� (r Cly OWNER
BLOCK / TRACT MAIL
ACT 6 % ADDRESS
SIZE OF LOT(p�jC/ ��NOW{ON LOTS CITY TEL. N0.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
LB1(i PG
CONTRACTOR
ADDREss CONNECTION DATA
i
STATION L DEPTH
CITr�T/Q TEL. N0, f MANHOLE REFERENCE
n
❑ STATE L JZL LOWER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO Y. TYRSfTIONP LTH L. MEL TO P.FROM
5�
J PUBLIC SEWER @ $3.50 -J
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVEREXTNFCESSPOOLOW PAGE PIT.L,DRYWELLRMANHIELD
OLE Q $2.00 CO. IMP. NO. J �l�s JOB N0.
HOUSE SEWER CONNECTING TO r /j
PRIVATE DISPOSAL SYSTEM Q 51.00 .TRUNK PERMIT NO. ROAD PERMIT NO-� ���4J
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION 1TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN DDAPPROVALS DATE INSPECTOR'SSIGNATURE
CON- -
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING
TO THE PUBLIC SEWER NEW ryt/^ NEW HOUSE SEWER
SIGNED THIS_ DAY
/O,FJ _Sel O 1641 CONNECT ADDITIONAL
OWNER OR OWNERS AGENT a/•./ ]V/SC,bL7 BUILDING K,WORK
�) SEPTIC TANK.SEEP,PIT(5)
ADDRESS7V')W1' ������ A//h h AND/OR DRAINFIELD
I HEREB ACKN LEDGE 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT J., AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI R /) ,/C9 , BACKFILL SEPTIC TANKS❑ l
SIGNATURE ,.11 vi/.T//,[�'/// SEEP. PIT(S) El CESSPOOLS �l
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER �ALIDATION ROBERT A. WOOD. CHIEF PLBG. IN ECTOR
".0.
CASH
;te4 5 6 8� Nov25 4 _. 4.50
J&E.66 APPLICATION FOR PERMIT
S&E-663 336
DIVISION OF BUILDING AND SAFETY SEWER-SEVtka DISPOSAL
Depwtmeni of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN "EAREST
CROSS ST. _
LEGAL
DESCRIPTION LOT NO, r� I ([J OWNER
BLOCK TRACT /J MAIL
//J 7 � ADDRESS
NO. OF LDGS.
SIZE OF LOT NOW ON LOT I- CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK
CONTRACTOR
ADDRESS 'ILdJ CONNECTION DATA
CIT L. NO, J STATION DEPTH
UllrTAREGISTRATION NO. JZ Ld'�i El COUTNTy MANHOLE REFE�ENCE UPPER
OWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
Y, CURB P.L. At.L. TO P.L.
PUBLIC SEWER § 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR a CO. IMP. NO. JOB NO.
WORK TO HOUSE SEWER I.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 00 PERMIT N0.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD .OD INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S S 1 o0
AUTHORIZATION TOTAL FEE Oe) REIMBURSEMENT FEE
IHAVE ED CON-
TRACTORTTOS CONNECT THE DATE ABOVE CTED WDESCRIBED EXISTING ITH THE HEREIN A IDWELLIING APPROVALS DATE INSPECTOWS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS--DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP, PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL I]
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT M THE LEGAL O HER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTI OPERTY. BACKFILL SEPTIC TANKS C
SEEP.PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION R.A. WOOD.CHIEF FLEIG. INSPECTOR
4999 DEC 10 4 //��' 2.00