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Home My Public Portal About9841 HOWLAND DR_Sewer__ 76A 642D -CE808 -10-7I APPLICATION FOR PERMIT � . COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGI BUILDING AND SAFETY DIVISING 55 "_C) C_) ITY 1 �ACpO�C \iI FOR APPLICANT TO FILL INIR BST. !}6 A/c3S DESC RGPTION LOT NO. S }�/� R pp A 9 oQ TRACT 7JJ BLOCK SS ( // NO. OF BLDG'. q SIZE OF LOT O Y NOW ON LOT �*.CY7(k Cl EL. NO. ` 7� ,r USE OF ��jj CT NO. GgOUP MPP PROLE SSEO BT BUILDINGS ReC 'I>�T/�C BK PG O CONTRACTOR 0 ADDRESS CCO CONNECTION DATA ON .2-1-,Z'2 DEPTH CITY TEL. NO. STATE LICOLE REFERENCE �]/ UPPER LICENSE NO. CLASS LOWER 40. DESCRIPTION OF WORK FEETYPE OFC i�[TICH LENGTH FROM HOUSE SEWER CONNECTING TO T. U6BJ P.L. M.L.TO P.L. PUBLIC SEWER ® $7.00 SEPTIC MNK.SEEI GE PIT OR P.C. NO. PITS AND/OR DRgINFIELD ® SIO.00 CO.IM O, JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. L PRIVATE DISPOSAL SYSTEM ® 53.00 \' CONNECT AODITIONAL YlBbTR J AFFIDAVIT welt' [ 45d[xT REG INSTR. NO. DATE u WORK TO HOUSE SEWER ® $3.00 `J OO V OVERFLOW SEEPAGE PIT.GRAINFIELD O EXTN..CESSPOOL.ORYWELL. ® $5.00 HW V.OR ST,WIDENING ALTER.REPAIR OR ABANDON HOUSE I- SEWER OR DISPOSAL SYSTEM ® f3.00 STATE ENCROACHMENT I'UJ MANHOLE ® $7.00 PERMIT NO. N ; L STRIAE WASTE WASTE APPROVnL OWNER'S PERMIT $ 3 00 CHARGES AUTHORIZATION TOTAL FEE 610CONNECTION 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. �T/I APPROVALS DATE INSPECTOR'SSIGNATURE SIGNED THIS DAV OF J� 1924 OWNER OR NEW HOUSE SEWER OWNERS AGENT /�C� T [-�[/-�-�lw^-loll\ CONNECT ADDITIONAL ADDRESS 05 A 41 1•'_-I BUILDING OR WORK ' 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TFNK.SEEP.PIT(S) ND/Ofl DRAINFIELD AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCEE S AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYW ELL [I I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR LICE NRED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY, ABANDON HOUSE SEWER SIGNATUPERMRE 'ACKFILL SEPTI C TANKS ❑ OF RTEE ❑ EP.PIT I51 ❑ CESSPOOLS VALMAPON <n. M.o, CASH _4T 5 &OPJAN 29 1 0 1) 6,0 0 ♦IQ5 C E 606 12-68 76A 642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION eUIIOING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 7 NEAREST FOR APPLICANT TO FML IN CROS GAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT 1� lJ ADDRESS INOF BLDG$. S12E OF LOT NOW ON LOT CITY TEL. NO. USE OF D18TRICT BUILDINGS U / SK MAP PROCESSED BY PG CONTRALTO 7fOQ /- 6 RES. ��(/. V / CFO NN�-'ECTION DA7A `, STATION ZT2.7 DEPTH STA LIC �/9 p/� PER 6N8E N CLAg �' MANHOLE REFERENCE /�{ C �.3J LOWER A. DESCRIPTION OF WORK FEE TYPE OF IOANG LENGTH FROM MOUSE SEWER CONNECTING TO �/ QO V. CURB P.L. M.L.TO P.L, J PUBLIC SEWER ® 35.00 V SEPTIC TANK.SEEPAGE PIT ORJOB NO. PITS AND/OR DRAINFIELD Q smoo CO.I.P.NO. 'so JOB No. HOUSESEWER C ONNECTING TO TRUNK PERMIT NO. ROAD PERMIT.0. Y PRIVATE DISPOSAL SYSTEM $3.00 O CONNECT ADDITIONAL BLOC.OR AFFIDAVIT 11Y {XS[X[Xi RECORD.INSTR.NO. GATE () WORKTO HOU SESEWER ® 53.00 OVERFLOW SEEPAGE PIT.GRAINFIELD "TN..CESSPOOL.DRYWELL.MANHOLE® $5.00 ALTER.REPAIR OR ABANDON HOUSE OR ST.WIDENING V SEWER OR DISPOSAL SYSTEM ® 33.00 W STATE ENCROACHMENT CL PERMIT NO, fn INDUSTRIAL Z WASTE APPROVAL OWNER'S PERMIT s z oo+ CHARGES AUTHORIZATION TOTAL FEE O f> ONN ECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TC-CONNECT THE ABOVE DESCRIBED EXISTING D1 G APPROVALS / TO THE PUBLIC SEWER. T IN ECTOR' SI ATURE SIGNED THIS DA OF 9— 1.�. OWNER OR NEW HOUSE SEWER ..V OWNERS AS T CONNECT ADDITIONAL ADDRESS �. BUILDING OR WORK 1 HEREB ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AN0 CT A N A INFIE.PIT 19) ND/OR DRAINFIELD AND STATE THAT THE ABOVE IS LAND S AND AGREE E COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING ANDK CESSPOOL Cl ORYW ELL ❑ I HERESY CET 1 AM PROPERLY EG TERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS BY L05 A S CO N AND STATE OF SEWAGE O'S POSAL SYSTEM CALIFORNIA 0 THE LEGA ANO INTEND TO AND RESIDE IN. ESCRIBED E IA OPERTY. DISCONNECT PLUG SEWER ABANDON HOUSE SEWER SIGNAT BACKFILL SEP IC NKS ❑ OF PERM ❑ SEEP,PITIS) CESSPOOLS 1 VALIDATION PACKALLEN UCK. W o. CASH SUPERVISING MECHANICAL ENGINEER Ar,_,4 7 7 1 8 MAY 41 0 D 7.0 0:" v 140RKERS'COMPENSATION DECLARATION 808 (260)D CE APPLICATION FOR PERM' I T CE 808 U 1 hereby affirm that I have a certificate of consent to self SEWER—SEWAGE DISPOSAL ' insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800. Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN CONNECTION DATA ❑ BUILDING p STATION DEPTH Certified copy is filed with the county building inspection ADDRESS /g ( O 1J`L� UPPER department. LOCALITY IG�t,rl,f i_.c MANHOLE REFERENCE LOWER C ' Date Applicant NEAREST TYPE OF CONNECTION LENGTH FROM CERTIFICATE OF EXEMPTION FROM WORKERS' OR?ss sr. L i s L L. L — Y. CURB P.L. M.L. TO P.L. COMPENSATION INSURANCE R.C. NO. OWNER ` tit' -`nJ CO. IMP, NO. JOB NO. (This sectionperm MAIL need not be completed if the work involved ADDRESS -O•✓L{') TRUNK PERMIT NO. ROAD PERMIT NO. } by the permit is for one hundred dollars ($100) or less.) _ AFFIDAVITIN SEME SRR R DATE G. CITY' TEL. NO. '2- G,— 76 6L O 1 certify that in the performance of the work for which this LEGAL permit is issued, I shall not employ any person in any manner DESCRIPTION LOT NO. HWY. OR ST. WIDENING so as to become subject to the Workers' Compensation Laws. s _ O BLOCK TRACT STATE ENCROACHMEN ~- Date Applicant62 NO. OF BEDGE. PERMIT NO, U NOTICE TO APPLICANT: If, after making this Certificate of SIZE OF LOT NOW ON LOT LU Exemption, you should become subject to the Workers' USE ELO BUILDINGS wRGEs 2 Compensation provisions of the Labor Code, you must forth- with comply with such CONNECTION CHARGE FEE p y provisions or this permit shall be CONTRACTOR deemed revoked. REIMBURSEMENT FEE LICENSED CONTRACTORS DECLARATION woo REss I hereby affirm that 1 am licensed under provisions of ChapterSTRICT R ROU BB MAP Pc PROC EsseO Br 9 (commencing with Section 7000) of Division 3 of the Busi- CITY rEL. No. ness and Professions Code, and my license is in full force and STATE LTC. effect. LICENSE NO. CLASS NO. DESCRIPTION OF WORK FEE USE SEWER CONNECTING TO FINAL. _2 -�—y VALIDATION License Number Lic. Class DATE �5 Contractor Date P ITS ASEPTIND/.E•U SEEPAGE eLOT OR FINAL uSs s CONNECTING TO BY ❑ rE DISPOYSTEM I em exempt from the licensing requiremeht5 as I am a CONNECT ADDITIONAL BLDG.DR -- U — Iicensed architect or a registered professional engineerCA acting in my professional capacity (Section 7051, Bus- ERPWW SE P. RA, iness and Professions Code). BxTHALTAR.REPAIR OR ABANDON OUSE SEWER OR DISPOSAL E Y A T.. Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION t I hereby affirm that I am exempt from the Contractor's OWNER'S Permit AUTHORIZATION License Law for the following reason (Section 7031.6, Busi- TOTAL FEE ness and Professions Code): L CON- IINI HAVE AT THIS DATE A I, as owner of the property, will do the work and the To=HE au TO IC SEWER.NNECT E neoN ETDesc RID ITH THE..PC EL X structure is not intended or offered for sale (Section SIGNED THIS DAY OF Is_ 7044, Business and Professions Code). WNBR OR :2 1 O.9,5 A HERS AGENT CONSTRUCTION LENDING AGENCY # e o I;e o �. 0 I hereby affirm that there is a construction lending agencyHADDRES for the performance of the work for which this permit is 2 0'0 ) tL 00 issued (Sec. 3097,Civ. C.). Lender's Name e'o'e 1 4,0 0 mo Lender's Address Oa 0 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all County ordinances and State laws regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date