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HomeMy Public PortalAbout9914 HOWLAND DR_Sewer__ 10-62 76A642o APPLICATION PP ICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONBUILDING > JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building / r LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS BT. LEGAL DESCRIPTION LOT NO. c�� 'yam OWNER MAIL BLOCK TRACT �� .'-9 'y~ ADDRESS L9 �FiJ�>'fs a.J •• _ NO. OF SLOGS. f I SIZE OF LOT NOW ON LOT c{'' CITY C: i•t���C!J•TEL. NO. USE OF BUILDINGS DISTRICT G��f jG��r� DISTRICT NO. GROUPMAP PROCESSED BY "BK PG CONTRACTOR �'•!�.(n•Cit%JCs'��� G-a' .�.�.�E'. �'� "afC�'% "� L—� / L ADDRESS ;,i., - .��_ .; �� -,�••�;A 'L-j �- CONNECTION DATA CITY TEL. NO.tPf�'.7 %/�Ca-7V ATION DEPTH '�� ©TSTA MANHOLE REFERENCE �„ {/�/' ) /J UPPER REGISTRATION NO. a.�a ❑ COUNTY 6.0 NO. DESCRIPTION OF WORK FEE TYPE OF CONNE TI LENGTH FROM O HOUSE SEWER CONNECTING TO Y. CUR P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 4z� '� `a P.C.NO. (� SEPTIC TANK,SEEPAGE PIT OR ! JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. /]/t HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 7 C. PRIVATE DISPOSAL SYSTEM @ $3.00 1! lL CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASE.ENT RECORD.INSTR.NO. DATE d WORK TO HOUSE SEWER @ $3.00 N OVERFLOW SEEPAGE PIT,DRAINFIELD z EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT $ 2 00 CHARGES AUTHORIZATION TOTAL FEE z 1 r r, CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLISEWER. APPROVALS ATE INSPECTOR'S SIGNATaUR$ SIGNED THIS DAY O/F'" 19_ OWNER OR NEW HOUSE SEWER �"' .� OWNERS AGENT lit CONNECT ADDITIONAL P ADDRESS BUILDING OR WORK 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 ❑ IHEREBY 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 OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVEDESCRIBED✓RESID@�TIAL PROPERTY. / / ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE/O/ J.�/' . �•.E/%=)/.� -1_ BACKFILL SEPTIC TANKS ElSEEP,PIT(s) El CESSPOOLS ❑ ALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH 2 8 4 3'�`O` NOV 22 1 o D 7.00 0 r U 7C E808 GA642 0.82 A I�PII OCATION ICOR 1�1C"RMOT Lrl 78A 842D /"`i l� IL. �`i Itl FOR II IC. IVl 9 �I`JII COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADD. I . ' WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FEL IN CROSS 5T. 61'-I,-'c,s ,/ LEGAL / _DES_CRIPTION LOT NO. ".fit"J OWNER MAIL BLOCK TRACT "l ^'�%.�� ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY /L y�'I r�C ��TEL. NO. USE OF BUILDINGS �rC':.� <yE's.T�G�' �i'CtI G'�'�✓ DISTRICT NO. GROUP MAP PROCESSED BY ,I / /�/X1 BK PG CONTRACTOR `,.��`%.'C-i!" ('�� .,/'L' ADDRESS ..J/ t. /f ySTA - CONNECTION DATA CITY�/���"H, ��L,.'/J ,i TEL. N0,0 y� � // 3 STATION ,[,moi/; DEPTH y REGISTRATION NO. //�-'+`�`�- ElCOUNTY MANHOLE REFERENCE /J�I 4I /J ./ UPPER NO. DESCRIPTION OF WORK FEE TYPE OF CO N 1 N LENGTH FROM d HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. O PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR c P.C.NO. U PITS AND/OR DRAINFIELD @ S10.00 CO.IMP. NO. JOB NO. ad HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. G O PRIVATE DISPOSAL SYSTEM @ $3.00 �... CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE W WORK TO HOUSE SEWER @ $3.00 tL OVERFLOW SEEPAGE PIT,DRAINF�ELD h EXTN.,CESSPOOL,DRYWELL,MA OLE @ $5.00 HWY.OR ST.WIDENING Z ALTER,REPAIR OR ABANDON SEWER OR DISPOSAL SY E @ $3.00 STATE ENCROACHMENT �. PERMIT NO. INDUSTRIAL E WASTE APPROVAL CHARGES 0�1TER'S PERMIT _ CONNECTION CHARGE FEE AUTHORIZATION I TOTAL 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 INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY 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 IAM THE LEGAL OWNER F, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO DESCRIBED REST ENTIA� PROPERTY. ABANDON HOUSE SEWER SIGNATURE �� OF PERMITTEE y.dr./.�• BACKFILL SEPTIC TANKS ❑ SEEP,PIT(S) ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. LrUO2 84 412 N10v22 1 1 D 2 5.00 D_82 76A6420-82 APPLICATION FOR PER IT 8A842 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS ( 1k,Q, WILLIAM A. JENSEN, Sup't of Building (� }- LOCALITY `k '- NEAREST FOR APPLICANT TO FILL IN CROSS ST. ' y`JI`c LEGAL DESCRIPTION LOT NO. OWNER �Cr MAIL BLOCK TRACT 'y ADDRESS `C.. NO. OF BLDGS. — 1 SIZE OF LOT /, NOW ON LOT CITY _�' �( TEL. NO. 1 USE OF / BUILDINGS � {,.� ',�.L �S DISTRICT NO. GROUP MAP PROCES �BY BK PG i ¢/ CONTRACTOR ,•� / _�. /L ✓L9 ADDRESS ��_.<, � ..,foCONNECTION DATA CITY TEL. NO / y�,I}�I�(� STATION :� d� ,1 DEPTH --STATE UPPER REGISTRATION NO. , (� LJ COUNTY MANHOLE REFERENCE J LOWER } a NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM O HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. (J PUBLIC SEWER @ $5.00 i SEPTIC TANK,SEEPAGE PIT OR ����/ PITS AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TR.L( ERy/ITy O ( 1 D{BERM PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT ECOR .INSTR. N . DATE/ N WORK TO HOUSE SEWER $3.00 n OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $5.00 ABA NDpN HOUSE HWY.OR ST.WIDENING ER OipnDii,Pe91!! SE Y TEM �T $3.00 cJ STATE ENCROACHMENT PERMIT NO, INDUSTRIAL WASTE APPROVAL CHARGES O RAS PERMIT s 2 00 AUTHORIZATION TOTAL FEE J /-v 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 SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK•SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD 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 OWNER OF, ND INTEND TO DISCONNECT PLUG AND " RESIDE IN. THE A E DESCR}BED RESIDENTIAL P 'PERTY. ABANDON HOUSE SEWER .. _ SIGNATURE OF PERMITTEE / /�" �t�,/� BACKFILL SEPTIC TANKS ❑ SEEP.PIT(S) ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD r/ 7 M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. ci w j 9 0 0 2t2 AM16 1 0 D 5,00~