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Home My Public Portal About6206 IVAR AVE_Sewer__ 76 6422 -63 76A642D + APPLICA ION FOR PER 11 -7 COUNTY OF LOS ANGELES SEWER EWAGE IS "'j S L DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS v' WILLIAM A. JENSEN, Sup't of Building /f' LOCALITY �L+y�j^y / C� - NEAREST FOR APPLICANT TO FILL IN CROSS 5T. LEGAL DESCRIPTION LOT NO. OWNER MAIL I BLOCK TRACT ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE DISTRICT NO. GROUP MAP PROCESSED BY BK PG� i' CONTRACTOR ; r / /J ''- ADDRESS15; J CONNECTION DATA C C TEL. NOl' Z., STATION / DEPTH ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO. ❑ COUNTY NO. DESCRIP ION OF'WORK FEE TYPE OF CONN CTION LENGTH FR q I HOUSE SEWER CONNECTING TO Y-1 9L URB P.L. M.L.TO P.LTA v PUBLIC SEWER @ $5.00 'SEPTIC TANK,SEEPAGE PIT OR P.C.NO. O CO.IMP. NO. PITS ANDOR DRAINFIELD @ $10.00 JOB NO.® V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 ^ CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER ERSI.ENT RECORD. INSTR.NO. D 0 TE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN.,CESSPOOL,DR YW ELL,MANHOLE @ $5.00 0' ALTER,REPAIR OR ABANDON HOUSE - HWY.OR ST.WIDENING N SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL q WASTE APPROVAL. OWNER PERMIT � 2 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 'I HAVE.AT THIS. DATE A.CONTRACT WITH THE HEREIN NAMED CON R EIMBURSEMENTFEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING jD/OR G To THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF '�Z�,Ty- OWNER OR {� a�fRrS% ) NEW HOUSE SEWER 140-e l�Z ? OWNERS ASi ' 7 ! 3/� - CONNECT ADDITIONAL BUILDING OR WORK ADDRESS1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP SEPTIC TANK,SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO AND�OR DRAINFIELD. WITH ALL COUNTY ORDINANCES ,AND STATE LAWS REPLUMBING AND SEWERS. - CESSPOOL ❑ DRYWELL ❑I HEREBY CERTIFY THAT PROIE RLY EGISTER ED ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED S ANGLES CO TY AND SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I E LEGAL OWN OF. ND DISCONNECT PLUG AND RESIDE IN, THE ABO RIBEDLABANDON HOUSE SEWER SIGNATURE BACKFILL SEP TANKS ❑ OF PERMITT SEEP,PIT(S)�CESSPOOLS ❑� V IDATIO Roe RT A. WOOD SUPERVISING•MECHANICAL ENGINEER - CK. M.O. CASH !'� 34. 34. 1 O.J0 76A 6420 -CE808-10-71 A, PP ICA'HON FOR PERM O � . COUNTY OFF LOS ANGELES SCI I(- If S IfSlGEWC ER-SE` AGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ^BUILDING ADDRESS LOCALITY 12 -- - -- NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL - OWNER DESCRIPTION LOT N�7C(..2�(.,4•�.«C L^--ale MAIL - BLOCK TRACT g ADDRESS �, -^7-Z�,,, _•,,,� NO OF BLDGS. ' SIZE OF LgZT(- NOW ON LOT CITY TEL. NO. USE OF .. _. -. BUILDINGS DISTRICT NO. GROUP MAP PROLE 'D BY , ��...// �) BK /y'�PG CONTRACTOR V / 0 ADDRESS CONNECT ION DA /M. STATION DEPTH CITY . EL. NO. / (/ '--7 STAT f/ LIC UPPER LICENSE NO;; V / GLA55 MANHOLE REFERENCE 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 @ $7.00 SEPTIC TANK,SEEPAGE PITOR P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRI\:ATE DISPOSAL SYSTEM @ $3.00 10- CONNECT CONNECT ADDITIONAL 0ZXW3=9b& AFFIDAVIT VI AlVER "EASEMENT RECORD.INSTR.NO. DATE O WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL. $5.00 O ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING F„ SEWER OR DISPOSAL SYSTEM Cs 83.00 STATE ENCROACHMENT W MANHOLE @ $7.00 PERMIT NO. d INDUSTRIAL N WASTE APPROVAL Z CHARGES T�OvWIpV�E�JRIS 7�} PERMIT s o� - AU 1L1Oi114ATIOltl TOTAL FEE 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_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL I ADDRESS BUILDING OR WORK M ' SEPTIC TA K.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRNAINFIELD 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 IAM 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 e RESIDE IN, THE ABO DESCRIBED RESIDE IAL PROPERTY. A13ANDON HOUSE SEWER SIGNATURE ❑ -' OF PERMITTEE BACKFILLSEPT ANKS _ SEEP.PITIS ESSPOOLS ❑ V /DATION CK. M,.O. CASH 4- MAY . 3 0 0 9.0 G '&"