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Home My Public Portal About5935 IVAR AVE_Sewer__ CE808 3-64 q p p p p� I ®pq 'g 76A642D P'il PLOCATION FOR PERMO ll ' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7NEAREST JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of Building 'FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. OWNER l MAIL BLOCK TRACT 0 ADDRESS NO. BLDGS. SIZE OF LOT NO ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY --- BK G CONTRACTOR �� ••� . 7 ADDRESS / CONNECTION DATA CITY TEL. NO. STATIO DEPTH STATE MANHOLE REFERENCE REGISTRATION NO. COUNTY W CLOWER NO. 1 DESCRIPTION OF WORK FEE TYPE OF ION LENGTH FRO HOUSE SEWER CONNECTING TO ,Syr, Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ 55.00 L/�f SEPTIC TANK,SEEPAGE PIT OR '� ® P.C.NO. >_PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. a HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 0 PRIVATE DISPOSAL SYSTEM @ S3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER I EASEMENT RECORD. INSTR.NO. DATE 0 WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ S5.00 V ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING 1.1 a SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT Z PERMIT NO. _ INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE AHAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE IN PECTO 'S SIGNATURE SIGNED THIS F 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL m� ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(5) 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 ABOVE DESCRIBE RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE /SI.� �.� BACKFILL SEPTIC TANKS E]OF PERMITTE //'�"�✓ SEEP,PIT(S) ❑ CESSPOOLS ❑ CASH TION ROBERT A.7K �� WOOD SUPERVISING MECHANICAL ENGINEER L ilo 6 8 3 DEC 1 1 0 A 7.0 0 M CE60E 3"E4 A DIOL OC p 1 OON FOR I�IC'®MOT 76A6420 /"i II-if ILe P'i I tl If" Ifs r IG.IfY�Vl u COUNTY OF LOS ANGELES "SEV1/ER-SEVNAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't o4 Building ^ LOCALITY av NEAREST FOR APPLICANT TO FILL IN CROSS ST. - LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT O 1'/ ADDRESS / ,�` ^��1� SIZE OF LOT NOWOON LOTS CITY '(,�jy TEL. .NO. J d USE OF f[( DISTRICT NO. GROUP MAP P O CESSED BY BUILDINGS •- .7 1, j/ CONTRACTOR i Z SQ �� B PCO p-LC.U1 ADDi2E55/ _ �' CONNECTION DATA 3 Cd9/ STATION DEPTH CITY TEL. NO. .7 O ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO. ❑ COUNTY. LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH 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. O PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM @ $3.00 Im CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER CASEMENT RECORD, INSTR.NO, DATE WORK TO HOUSE SEWER @ $3.00 O OVERFLOW SEEPAGE PIT,DRAINFIELD V EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 y,[ A�.FERrit6PMA-6 R ABANDON HOUSE -^ HWY.OR ST.WIDENING d DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT h PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT _ $ 2 00 AUTHORIZATION I TOTAL FEE ;!5� / 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 SEW �- APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS- Y OF ! 1� OWNER OR a NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL E BUILDING OR WORK ADDRE5 ( SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HA E READ THIS APPLICATION gND/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 C3DRYW ELL [I 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, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVy,5 DESCRI ED ESI N IAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE ♦ S BACKFILL SEPTIC TANKS OF PERMITTEE ❑ /{ SEEP,PIT(5) [I CESSPOOLS �O J 1.�-�.1v�1„c AA VALIDATION ROBERI' AVWOO ly SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH