HomeMy Public PortalAbout9954 HOWLAND DR_Sewer__ ,0-63
76A642D _ APPLICATION FOR PERMI
6A64
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST ,
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. J 3 MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY �.TEL. NO.
.. USE OF
LDINGS
ZZr
DIB . GROUP MA CT NOK •• �
BUI \/OPROCESSED BY
Bi
PL 4Z
CONTRACTOR
ADDRESS CONNECTION DATA
i CITY TEL. ST 4
ON �f DEPTH
El STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. �. ❑ COUNTY'
NO. DESCRIPTION OF WORK FEE TYPED ONN T LENGTH FROM
HOUSE SEWER CONNECTING TO Y. C P L. M.L.TO P.L. >_
PUBLIC SEWER @ $5.00 �� O
SEPTIC TANK,SEEPAGE PIT OR P.G.NO.
CO. IMP.NO. 1.2- -76
,meq/, JOB NO.
PITS AND�OR DRAINFIELD @ $10.00 "— I ,(^ U
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO Sl
PRIVATE DISPOSAL SYSTEM @ $3.00 0-
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE
WORK TO HOUSE SEWER @ $3.00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD W
EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $5.00 J C
ALTER.REPAIR OR ABANDON HOUSE H I H
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCRO HMEN
I PERMIT NO.
INDUSTRIAL c.�-..
WASTE APPROVAL
OWNERS PERMIT $ 4NM2E.�CO.LN
CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
-1 HAVE AT THIS DATE A CONTRACT WITH THE HEREI - REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED E STING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY F 19_
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,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 [3DRYWELL El
I HEREBY CERTIF THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS RE I Y LOS AN
S COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR I THE LEG WNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, TH OV ESCRIBED IDE IAL ROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE ❑
SEEP,PIT(S) ❑ CESSPOOLS
VALIDATIO ROBERT A. WOOD
CK. -.0. CASH SUPERVISING MECHANICAL ENGINEER
LrCo 6 2 3 4 PICU 2 7 1 0 D 7.0 0- 7
o-63
76A642D APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWEFZ-SEV1/AGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 00,
JOHN A. LAMBIE, County Engineer ADORE
WILLIAM A. JENSEN, Sup't of Building
LOCALITY y� _
_ .- .. -, - _,a. .._,_..r.-i. NEAREST
FOR APPLICANT TO FHL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO 1 T� OW
M
BLOCK TRACT ADDRESS
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS O.DISTRICT NGROUP MAP ROC ESSED BY
BK PG_
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL. ION DEPTH
-.--yam
REGISTRATION NO.
❑ COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIOW L NGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. }
PUBLIC SEWER @ $5.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO. d
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT
PRIVATE DISPOSAL SYSTEM @ $3,00 VV
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVED EASEMENT RECORD. INSTR. NO. DATE O
WORK TO HOUSE SEWER @ $3.00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD U
EXTN.,CESSPO L,DRYWEL L,MANHOLE @ $5.00 a
ALTER.RE 1 OR ABANDO HOUSE H ST ID N h
SEWER O POSAL SYS @ $3.00 STATE ENC ROA MENT
PERMIT N
INDUSTRIA
WASTE AP RO L
OWNER'S PERMIT g CHARGES
AUTHORIZATION I TOTAL FEE i J� 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 D F19_
OWNER OR l_ NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
I HEREBY ACKNOWLEDGE THAT I 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 - ,
r PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED A DOR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIR D BY LOS ANGLEeCTY AND ST E OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH M THE LEGAL OF, A I ND T DISCONNECT PLUG AND
RESIDE IN, THE A E SC IB D RESIABANDON HOUSE SEWER
GNATURE ILL SEPTIC TANKS ❑
OF PERMITTEE ❑
SEEP,P CESSPOOLS
VALIDATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
tt�,� 6230 NOV 2711 D 25.00N