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HomeMy Public PortalAbout6209 IVAR AVE_Sewer__ GEBOD 3-62. -�- APPLICATION FOR PER IT /�. `*6A64 FD COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND-SAFETY DIVISION FLOCALITY ING JOHN A. LAMBIE, COUNTY. ENGINEER ESS / C✓ • COLEMAN W. JENKINS. SUPT. OF BUILDING y ...,,. .e.., ..., _ - t NEAREST FOR APPLICANT TO FILL IN `ROSS ST., � LEGAL DESCRIPTION LOT NO. OWNER �•��C �"` , .. - MAIL .. ..: C BLOCK TRACT -< ADDRESS Sl _ �. r NO. OF BLDGS. SIZE OF L0 ✓ NOW ON LOT CITY TEL: NO. USE OF DISTRICT NO. GROUP _MAP PROCESSED BY BUILDINGS - - BK PG//��// CONTRACTOR G✓ /I�G� �..� ,•�- `'.+ ADDRESS ` CONNECTION DATA - CITY TEL.' _ STATION DEPTH UPPER STATE 1 - � LIG — _ MANHOLE REFERENCE �� LICENSE NO, � QLA' ✓✓✓ NO. DESCRIPTION OF WORK FEE., TYPE OF CONNECTION LENGTH FR HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L( d PUBLIC SEWER @ $5.00� O SEPTIC TANK.SEEPAGE PIT OR - NO.' PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.-NO. - JOB NO: (J HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. -'ROAD PERMIT NO. O "PRIVATE DISPOSAL SYSTEM' @ $3:00 / CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE I- WORK TO HOUSE SEWER @ $3.00 - IV OVERFLOW SEEPAGE PIT.DRAINFIELDIL EXTN..CESSPOOL.ORYWELL.MANHOLE @ $5.00 - ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING z SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. _ INDUSTRIAL. ' WASTE,APPROVAL.'- �z CHARGES OWNER'S PERMIT S 2 00 AUTHORIZATION TOTAL PEE CONN EGTION CHARGE FEE - I ' 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 INS TOR'S G TURE SIGNED THIS - DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDINGOR WORK- ADDRESS SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ TH IS 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 ❑. 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 RE51 IN. —ABOV SCRIBED ES Fk TI AL PROPERTY. ABANDON HOUSE SEWER ACKFILL SEPTIC TANKS ❑ SEEP.PIT(5) ❑ CESSPOOLS'❑ , VALIDATIO JACK R. ALLEN' SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH CE8083-62 i APPLICATION FOR PER T 76A642W ` COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER 4- -• BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER AooREss io[ COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS ST: LEGAL % ©� OWNER V DESCRIPTION 'LOT NO. f+ MAIL BLOCK TRACT - ADDRESS. - r� NO. OF BLDGS. SIZE OF LOT NOW ON-LOT• _ CITY USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS -BK PG f !y//J] CONTRACTOA, R O/ j 'r ADDRESS CONNECTION DATA CITY L. NO. STATION DEPTH E ® E STATE LIC MANHOLE REFERENCE UPPER LICENSE NO:, GLASS NO. .DESCRIPTION OF WORKFEE TYPE OF CONNECTION LENGTH FR M HOUSE SEWER CONNECTING TO Y. CURB 'P.L. M.L.TO P.L� d PUBLIC SEWER @ $5.00 O P.C.NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. V PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO- HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ S3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE I- WORK TO HOUSE SEWER @ S3.00 W OVERFLOW SEEPAGE PIT.DRAINFIELD d EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 H ABANDON HOUSE c HW,Y. OR ST.WIDENING az SEWER OR DIS SAL SYSTEM $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL • OWNERS PERMIT $ 21 00 CHARGES AUTHORIZATION TOTAL FEE 1 CONNECTION CHA GE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE T 'RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIN DWELLING TO THE PUBLIC SE R. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF lie OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PITIS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL 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 ORTHAT AM THE EGAL OWNER OF, AND INTEND TO �� DIS ECT PLUG AND RESIDE IN, THE AB SCRI D REST N IAL PROPE ND HOUSE SEWER / f SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ElCESSPOOLS ❑ VALIDATION JACK R. ALLEN CASH SUPERVISING MECHANICAL ENGINEER 8759 D 5.0 S AE-6D !tAPYID® ICtlSTO. FOR PERMIT N®99IT S&E•663 3.55 /J•�U ®® do ��990"9 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer _ County of Los Angeles BUILDINADDRESS G G3 lJ // jH r✓/ WM.J. FOX. COUNTY ENGINEER � ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT To FILL IN C,.r sr.LEGL D SCRI.PTION LOT NO. ;z T—a)t- OWNER BLOCK TRACT � Q f MAIL ADDRESS �� NO. OF BLDGS. SIZE OF LOT _ NOW ON LOT CITY TEL.TEL. NO. USE OF BUILDINGS DISTRICT NO.. GROUP MAP I I BK PG CONTRACTOR � o ADDRESS J . CONNECTION DATA CITY TEL. NO. STATION '�'�-2u DEPTH aa" �1 r ATE MANHOLE REFERENCE UPPER REGISTRATI N N0. . ❑ COCOUNTY': / "O No. DESCRIPTION OF WORK,; FEE TYPFr!MYECTION LENGTH FROM gn HOUSE SEWER CONNECTING TO - Y. CURB P.L. hi.L. TO P.L. PUBLIC SEWER Qa $ 3.50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR a //�� P. C. N0. V/ORK TO HOUSE SEWER 1.00 CO. IMP. NO. �) (,�1 JOB NO. ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.32S 74 _ 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 CONNECTION CHARGE FEE OWNERS PERMIT - - 5 1 00 AUTHORIZATION I TOTAL FEE h REIMBURSEMENT FEE TRACTORHAVE T OS CONNECTDATE O THEAABOVECTED yVDESCR BED EXISTINGITH THE A DWELLING - APPROVALS DATE INSPECTOR'S SIGNATURE TO THE,PUBLIC SEWER SIGNED THIS DAY OFLtCt, •l. Ig - NEW HOUSE SEWER OWNER OR f� ):� r ,� .�� BCONECT UNLDING OB WORK AL OWNERS AGENT ADDRES ogleI SEPTIC TANK,SEEP, PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE HAT I HAVE READ T P LICA 0 CESSPOOL[IDRYWELL[] AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO Y WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES .COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL WNER OF THE A OVE ABANDON HOUSE SEWER DESCRIBED ��ESIDE T AL PR ERT BACKFILLS,' J* / /�/ CESSPOOLS �e .slsR,Arfl./ NATU OF PERMITTEE Q WILLIAM J.'FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR s,A.G 1 7 1 3 Y1 45 0 °!