HomeMy Public PortalAbout6240 IVAR AVE_Sewer__ APPLICAT�ON FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles '` BUILDING,,O ��8®
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS !J '
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY s
FOR APPLICANT TO FILL IN CROSS s.
LEGAL A ®� ® FA p� OWNER
8 DESCRIPTION LOT NO. F c�J
�04- MAIL
BLOCK TRACT
6ADDRESS ..
NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT - NOW ON LOT -
USE
OF
BUILDINGS 'DISTRICT,NO. GROUP MAP
BUI
BK /P��G
CONTRACTORS � � M ®a Rf
ADDRESS CONNECTION DATA
CIT 0 .TEL. NO STATION DEPTH
f MANHOLE REFERENCE UPPER,
v i+ �^[J STATE - S A .�.�� LOWER
REGISTRA ION NO� � Yl ❑ COUNTY ,
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE 0 ,r) LENGTH FROM
Y
PUBLIC SEWER .@ $3.50 E e ' CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELDP'. C. N0,
EXTN.,CESSPOOL,DRYW ELL,M AN HOLE @ $2.00 CO. IMP. NO. f! ® JOB NO.
HOUSE SEWER-CONNECTING TO �� r��
PRIVATE DISPOSAL SYSTEM @ $1.00 o TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR '= STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO. '
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES -
~ CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE eVPr3 REIMBURSEMENT.FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- APPROVALS_ DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ...
' TO THE PUBLIC SEWER. NEW HOUSE SEWER �� � � x _
SIGNED THIS DAY OF 19 n CONNECT ADDITIONAL .
OWNER .OR - BUILDING OR WORK -
OWNERS. AGENT' SEPTIC TANK,SEEP, PIT(S)
ADDRESS 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 DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
- CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE A OVE
DESCRIBED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS❑'
SIGNATURE SEEP.PIT(5) ❑ CESSPOOLS[I
OF PERMITTEE -
x:
JOHN A. LAMBIE, COUNTY ,INEER� k� ALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR'
CK. M.0. CASH
t'co 5 C;n JUs'I?3 4 , 4.5 0 '�
76A842D � i APP��CATO®UFI FOR 11 PERWFJ11I .
S&fi-868 I I X55 \ '
'. DI�TISIORT OF BUILDING AND SAFETY SEWER
—SEWAGE ®9 S POSA L _
} Department.of County Engineer
County 'of Los Angeles BUILDING / p
JOHN A. LAMBIE , COUNTY ENGINEER_ ADDRESS [ipift
® CASS.4TT D. GRIFFIN, SOFT op BUILDING F' LOCALITY � 7i i;bD IF a 1}-`r .
NEAREST J
FOR APPLICANT TO- FILL IIV ceoss ST. L rr'L�
+� LEGAL. '''iiia •-� -
` DESCRIPTION it 08
LOT NO; /I M a A -7 OWNER _
MAIL ,q
BLOCK TRACT ea ADDRESS _ ({ /!JNO OF
BTEL. NO.SIZE OF LOT NOON CITYj `h $ T •�'/O ./
USE OF DISTRICT NO GROUP. MAP
BUILDINGS �// - BK PG ,
3 CONTRACTOR e.C/ /"�G/C..yl 4,rm 57
ADDRESS /Q 2-10 ! vA rZ CONNECTION DATASTATION ,
CITY T�2N` !�/� Ci'/» TEL. NO. MANHOLE REFERENCE �`' _DEPTH
UPPER
h pr ❑ STATE LOWER
REGISTRATION N0. Cl COUNTY
No. DESCRIPTION OF WORK FEE
TYPE 0 CONNECTI N LENGTH FROM _
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50 -
SEPTIC TANK,SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXT.N.,CESSPOOL,DRYWELL,MANHOLE @ $ 2.00 CO. IMP. NO. JOB 0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 § TRUNK PERMIT NO., AD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE.SEWER @ $1.00 '" PERMIT NO.
k'T�n+e,r•-Rte,;-gin�n ABANDON HOUSE j / INDUSTRIAL
3R DISPOSAL SYSTEM @ $1.00 • WASTE APPROVAL
° CHARGES -
CONNECTION CHARGE FEE _
OWNER'S PERMIT 5 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS -Z- OF 04926, 195-7 CONNECT ADDITIONAL �/
OWNER OR /�/j//, _BUILDING OR WORK /•i�,3- i
OWNERS AGENT A/� ��'0'� SEPTIC TANK,SEEP, PIT(S)
ADDRESS • �G � /--Oil�v�-!'. (.Kfs AND/OR DRAINFIELD
x I HEREBY ACKNOWLEDGE THAT 1 HAVE READ TAS APPLICAT ON 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
1 HEREBY CERTIFY THAT' I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE �7 6J1;r
DESCRIBED RESIDENTI ROPERTY. , BACKFILLS �S
SIGNATURE .-
OF PERMITTEE _
^x>
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M. 0. CASH
�_, �0 7 4 0 8 APR 2 2 4 3.0 0 In