HomeMy Public PortalAbout6106 IVAR AVE_Sewer__ f
�• 76A642D CATION: FOR PERMIT.
S&E-663 12.54 A®
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
ADDRESS I rf A �6 ? r10. ,�!I.��//-.:V.f'
WM. J. FOX, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITT
FOR APPLICANT TO FILL INNEAREST
LEGAL
�('') 1. CROSS ST.
Ed
DESCRIPTION. LOT NO. 67 ,5 'Cl/ 7,0199 '
BLOCK TRACT �)�9 0 MAIL A /
- DDRESS. / 4111'
�,�A=' _�,r /il ,/.I_.�i%+t� ..1 />•`��E'�'�
N0. OF BLDGS.
SIZE,OF LOT NOW ON LOT CIT�Y�Q�A�"✓G!P.-4:'_':i.2t.�.� � TEL. NO.
USE OF
BUILDINGS 11 �ail/.J�,(C//J.f 1>� DISTRI/C 0,. I GROUP I MAP,EK PG-
CONTRACTOR
ADDRESSV A'A ��)��A�1 CONNECTION DATA
n
CITY(f��� fir. J TEL. NO, o 7a47 L? STATION ! ( r J; DEPTH z P
`✓'/� ❑ STATE r ANHOL EFEREN f , l
REGISTRATION NO. ❑ COUNTY , LOWER
TYPE J�'C'a!(,[JECTION LEN H FROM
NO. DESCRIPTION OF WORK FEE Y. CURB ) P.L. M.L.TO P.L. - J
HOUSE SEWER CONNECTING TO tt
PUBLIC SEWER @' $ 3.50
HOUSE SEWER CONNECTING TO —
PRIVATE DISPOSAL SYSTEM 1.00
JCONNECT ADDITIONAL BLDG. OR �� CO. IMP. NO. / 3V JOB. NO.
WORK TO HOUSE SEWER 1.00 6-
ALTER OR REPAIR EXISTING �
SEWER OR DISPOSAL SYSTEM COD TRUNK PERMIT NO. ROAD PERMIT NO. !7
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM. 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR —
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S $ 1 00
AUTHORIZATION TOTAL FEE _ �(� REIMBURSEMENT FEE
TRACTORHAVE TTOS CONNECT THE DATE ABOVECTED WDESCR BED EXISTINGITH THE HEREIN ^^DWELLIED NG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED NEW HOUSE SEWER THIS DAY OF 19- %2• ti ./
r
OWNER OR CONNECT ADDITYONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK, SEEP, PIT(S) .
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND .AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER-OR
PLUMBING AND SEWERS.
. SEWAGE DISPOSAL-SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED ASREQUIREDBY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND.
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL
12 ,; CESSPOOLS
SIGNATURE
OF PERMITTEE ..
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
AC06 9 8 2 AUG 22 4 5.5 U 41
BY BY -
-. DEPUTY _ DEPUTY
BY BY
:.® DEPUTY DEPUTY
PPP' / II
T6A 642D-CE808 A-7/76 APP B CLTUON FOR
m2RM O I
_SEWER—SEAGEDIISPOSAL
IILJII
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
APPLICANT
q
BUILDING AND SAFETY DIVISION
FORAPPLICANT TO FILL IN DISTRICT��NIIO��. GROUP SK MAP PS rRROOCESSED BY °
BUILDING l/O lrl �'� ,N� '
ADDRESS VV �r!/ q7l ccul�iiV�?
CQNNECTION DATA
LOCALITY
NEAREST STATION EPTH �r/�„Q� i
CROSS ST. ./�jr+."-�' - G��/�'
�y MANHOLE REFERENCE _ UPPER
OWNER // �O LOWER
,oMIf TYPE OF CONNECTI N LENGTH FIRCOW
MA'L Y. CURB P M.L.TO P.L.
, G.
.N17 O.
- CO. IMP. NO. JOB NO.
CITY 'TEL. NO.;)_ A
LEGALJ D / TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO
AFFIDAVIT w�IVER EABEMERr I RECORD.INSTR.NO. DATE
BLOCK TRACT
NO. BLDGS. _
SIZE OF LOT /.� ,L+'j NOW ON LOT HWY. OR ST.WIDENING '
USE DSTATE ENCROACHMENT
BUILDINGS, PERMIT NO. .
INDUSTRIAL
CONTRACTOR 'E� WASTE APPRO,VALti ..
ADDRESS j i'7�,`�. - CHARGES)
CONNECTION CHARGE FEE
CITY. TEL. NO.
STATE O LIC REIMBURSEMENT FEE
LICENSE NO., GLASS
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE LU
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ y
SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWER
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL �� e
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM SEPTIC TANK.SEEP,PIT(S)
CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL ❑ ORYWELL ❑
EXTN..CESSPOOL.DRYWELL.MANHOLE
ALTER,REPAIR OR ABANDON HOUSE
ALTER.REPAIR.SEWER OR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS ❑
SEEP.PITS) ❑ CESSPOOLS ❑
OWNER'S issuance Fee s
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION`p
AUTHORIZATION11 TOTAL FEE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
I-HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON PLUMBING AND SEWERS.
TRACTOR TO CONNECT,THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR
TO THE PUBLIC SEWER. LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE.OF
SIGNED THIS DAY OF IJ CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO.
OWNE RESIDE IN, THE AS DESCRIBED RESIDENTIAL PROPERTY.
OWNE SIGNATURE
ADPRESA OF PERMTTTEEII
-- VALIDATIO '
M.O. CASH / ��^^�, (�
0 8 g�i� J v 1
R 11 D. .V V A)
ceeoa e•sa COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FEAREIT
,/
JOHN A. LAMBIE, County Encino !� N ,
CASSATT D. GRIFFIN, Supt of Building ���y[ /B
,.m:.
FOR APPLICANT TO FILL INLEAL
pv�•
DESCRIPTION LOT NO.IVOe)l O-(Y e, OWNER
J
MAIL /
BLOCK TRACT S ADDRESS �!o 061'e,
NO.OF BLDG9.
'SIZE OF LOT y a NOW ON LOT CITY�P
USE OF a '
BUILDINGS fi!e- e- u, DISTRICT NO. GROUP I BK- PG MAP P CESSED I L
CONTRACTOR
i
ADDRESS CONNECTION DATA .
h
CITY TEL.NO. STATION DEPTH
'. REGISTRATION NO. COUNTY STATE MANHOLE REFERENCE UPPER
AI LOWER -
No. DESCRIPTION OF WORK FEE_ Qn �L
HOUSE SEWER CONNECTING TO 7 O
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. -
PITS AND/OR DRAINFIELD @ $3.00
- OVERFLOW SEEPAGE PIT,DRAINFIELD -
EXTN.,CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO - P.C.NO.
_ -PRIVATE DISPOSAL SYSTEM @ $1.00 CO-IMP.-NO. J09 NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. - ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 - PERMIT NO.
INDUSTRIAL -
" WASTE APPROVAL
b
CHARGES
OWNER'S PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ' REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEREINMED CN.
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19- ~'. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT���' ""� BUILDING OR WORK 0 i1t.rTY.�
{ ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ.THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ CESSPOOL ❑ DRYWELL ❑ '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -; ECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE '
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑ _
SIGNATURE �e' l;
SEEP.PIT(S) Cl CESSPOOLS ❑ -
OF PERMITTEF �i���
®v _ VALIDATION ROBERT A. WOOD
CK. M.0. CASR SUPERVISING MECHANICAL ENGINEER
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