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Home My Public Portal About10513 KEY WEST ST_Sewer__ °'82 76A0A642D APPLICATION FOR PERMI 842 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING S-► JOHN A LAMBIE, County Engineer ADDRESS WILLIAM A JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLI ANT TO FILL CROSS ST LEGAL // I� / o 14 DESCRIPTION LOT NO OWNER �/ / 1 6� MAIL �s BLOCK TRACT ADDRESS NO OF BLDGS �F SIZE OF LOT NOW ON LOT CITY TEL NO F- ( 7 USE OIF BUILDNGS h ^ DISTRICT NO BK PG GROUP MAP PROCESSED BY �+K.! !� - CONTRACTOR �oi ` r ADDRESS 11 i' !r7- CONNECTION D TA CITY TEL NO A D LAOSs� jAe. DEPTH / ❑ STATE MANHOLE REFERENCE UPP REGISTRATION NO Q ❑ COUNTY NO DESCRIPTION OF WORK FEEYPE OF N CT N ENGTH F HOUSE SEWER CONNECTING TO AAl Y P L M L Top PUBLIC SEWER @ i5 00 C/ l/ PC NO V SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO PITS AND/OR GRAINFIELD @ E1000 Qf� HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DAT WORK TO HOUSE SEWER @ $300 _ OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT 8 21 00 - CHARGES AUTHORIZATION TOTAL FEE •nen CONNECTION CHARGE FE N AMED CON E I HAVE AT THIS DATE A CONTRACT WITH THE HEREIREIMBURSEMENT 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��v j(/v�J CONNECT ADDITIONAL 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 ALL 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 OR THAT I AM T E LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE E RIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATIONS ROBERT WOOD CK M O SUPERVISING MECHANICAL ENGINEER CASH cu 9 -912C.31 SEP 61 0 D 7.0-b— CSA ,O_g2 6A64 7 842D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN. Supt of Building LOCALITY NEAREST Al _A FOR APPLICANT TO FILL CROSS ST F^ )k FAN LEGAL }' //� i D DESCRIPTION LOT NO OWNER f��' (� A ` MAIL s BLOCK TRACT ADDRESS ✓/'�/—J NO OF SLOGS ' y SIZE OF LOT NOW ON LOT CITY TEL NO / Aj� ` 40 USE OF BUILDINGS DISTRICT NO GROU MAP PROCESSED BY BK PG CONTRACTOR r ...�--� ADDRESS CONNECTION DATA CITY TEL NO 'O &® ST 1 DEPTH STATE MANHOLE REFERENCE - PPER REGISTRATION NO IF COUNTY NO DESCR IP ION OF WORK AE YPE CO 1 E LNGTH F OM HOUSE SEWER CONNECTING TO M L TOP _ PUBLIC SEWER $5 00 SEPTIC TANK SEEPAGE PIT OR P C 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 $300 J CONNECT ADDITIONAL BLDG OR AFFIDAVIT w --CORD INSTR NO DAT WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWE OR DISPOSAL SYST Q $300 STATE ENCROACHMENT S PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT CHARGES AUTHORIZATION TOTAL FEE 1 l/7 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 - l NEW HOUSE SEWER OWNERS AGENT � �/�/ CONNECT ADDITIONAL ADDRESS - BUILDING OR WORK SEPTIC TANKSEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAI NFIELD -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LDE AND SEWERS CESSPOOL ❑ DRYWELL ❑ CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR S REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGEDI S POSAL SYSTEM OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND THE ABOV D SCRIBED RESIDENTIA PROPERTY ABANDON HOUSE SEWER qCKFILLSEPTIC TANKS ❑TTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATIOIN--� ROBERT A WOOD cgsH SUPERVISING MECHANICALALENGINEER CK M o (jam 9 9 .1,3 SEP 6 1 1 D 2 Jc a 0 v