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Home My Public Portal About6036 IVAR AVE_Sewer__ 1 CE608 3-62 76A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING \3 JOHN A. LAMBIE, County Engineer ADDRESS �p �p v WILLIAM A. JENSEN, Sup't of Building `� �•�. I LOCALITY i Qkv- ..-s.:,.. - "' "'_ NEAREST ' 1 FOR APPLICANT TO FILL IN CROSS ST. DESCRIPTION LOT NO. \A)LEAL ` � OWNER MAIL BLOCK TRACT S ADDRESS ` `/p 7 70,\' SIZE OF LOT.,J L,Lr/( r�'j NOW OON LOTS CITY TEL. NO. USE OFc, ` ` DISTRICT NO. GROUP MAP PROC ESSE BY BUILDINGS ,� C tri BK PG CONTRACTOR \ ADDRESS \ , !lIYYY CONNECTION ATA CITY ^'a�. TEL.'N 0. P% k3 '2, STATION DEPTH ❑ STATE UPPER REGISTRATION NO. ❑ COUNTY MANHOLE RE :NCE LOWER - NO. DESCRIPTION OF WORK FEE TYPE OFC NECTION LE FROM HOUSE SEWER CONNECTING TO Y. CU P.L. TO P.L. PUBLIC SEWER @ $5.00O SEPTIC TANK.SEEPAGE PIT OR 0 NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ S3.00 CONNECTADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEME RECO INSTR.NO. DATE WORK TO HOUSE SEWER @ S3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL.MAN HOLE @ $5.00 HWY. OR ST.WIDEN ABANDON HOUSEI G DISPOSAL SYSTEM @ $3.00 - "' STATE ENCROACH ENT PERMIT NO. - INDUSTRIAL ' WASTE APPR VAL CHARGES OWNERSPERMIT $ 2 Oo AU'T'HORIZATION TOTAL FEE 0L0 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 SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ F_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 1 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 ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANGL COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL O NER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AAOVE'Z7{SCRIB ED RESI NTIA` PR P TY. ABANDON HOUSE SEWER SIGNATURE JJ - BACKFILL SEPTIC TANKS �LjC a OF PER MffTEE SEEP.PIT(S) E) CESSPOOLSvk/610 A_ tel✓l2r VA IDATIO ROBERT A. WOOD CK. O. CASH SUPERVISING MECHANICAL ENGINEER L .Ail'o 0 3 3 9:3 FEB 13 1 0 A50~ �1 Xia (/ CEBDB3.62 76A 642D APPLICATION ION FOR PERMIT /l\I�P /"'/�f♦ BVI COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Bu DILDING JOHN A. LAMBIE, County Engineer ADRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLIC NT TO FILL IN CROSS ST. _ LEGAL DESCRIPTION LOT NO. f , ,Q12,3 OW NE MAIL BLOCK TRACT O �• ADDRESS - NO. OF BLDG5. r SIZE OF LOT NOW ON LOT .1) CITY TEL. NO USE OF DISTRICT NO. GROUP MAP PROCES E BUILDINGS (� BY BK PG CONTRACTO y '`, _ 91 7 f ADDREss ® /^ CONNECTION DATA CI L. NO. Q STATION I G DEPTH TATE MANHOLE REFERENCE a] REGISTRATION NO. / ��/ �` ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPE OFC T ON LE H FROM HOUSE SEWER CONNECTING TO �.r 0® Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR 330 P.C.NO. PITS AND/OR DRAI NFIELD @ $10.00 CO.IMP. NO. JOB NO. U HOUSE SEWER 16NNFC71NG TO TRUNK PERMIT NO. ROAD PERMIT PRIVATE DISPOSAL SYSTEM @ $3.00 ® CONNECT ADDITIONAL BLDG.OR �� AFFIDAVIT WAIVEp EASEMENT RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELO EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR VISPOSAL S STEM @ $3.00 STATE ENCROACHMENT i PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'SI PERMIT $ 21 Oo CHARGES CONNECTION CHARGE FEE AUTHORIZATION rTOTAL FEE ®'a I HAVE. AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DE CRIBED EXISTING DWELLING : TO THE PUBLIC SE-` Rq ,; APPROVALS DATE INSPEC%O R'S SIGNATURE i .SIGNED THIS_ D Y OF 1�/.ryq/ OWNER OR /_ NEW HOUSE SEWER J Jf/ /4 OWNERS AGEN�- -'� CONNECT ADDITIONAL Y BUILDING OR WORK ADDRESS 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 ALLCOUNTY 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 THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, M THE ABOV DESCRIB D RESIDENTIIA�L P OPERTY. ABANDON HOUSE SEWER SIGNATURE //� ry..� El - OF PERMITTEE BACKFILL SEPTIC TANKS SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION,,-) ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL- ENGINEER