The URL can be used to link to this page

Home My Public Portal About10515 KEY WEST ST_Sewer__ I wzJ CES08 ,D_82 78AG42D APPLICATION FOR PERMI 84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engmeer ADDRESS , WILLIAM A. JENSEN, Supt of Buildmg LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL C �l/" I 1� DESCRIPTION LOT NO OWNER MAIL 5 BLOCK TRACT ADDRESS I/7 �G�✓ NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO / USE OF q BUILDINGS DISTRICT NO I GROUP MAP PROCESSED BY efl_ BK PG CONTRACTOR ADDRESS V / .-- 15 r CONN CTION DATA CITY TEL NO�.. v S A ON ,ate DEPTH p+� ❑ STATE MANHOLE REFERENCE �{� UP (/ REGISTRATION NO ❑ COUNTY NO DESCRIPTION OF WORK FEEyPE OF N C O LENGTH FRO HOUSE SEWER CONNECTING TO Y M L TO P L PUBLIC SEWER $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ $1000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DA E WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 a HARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE R I HAVE AT THIS DATE A CONTRACT WITH THE HEEIN AMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DINTE® INSPECT;R S SIGNAT RE SIGNED THIS DAY OF 19_ OWNER ORNEW HOUSE SEWER �(( OWNERS AGENT� � _ / CONNECT ADDITIONAL �' r ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ ORYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS 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 - RESIDE'IN THE ABOV D SCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER ' SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ ' EEP PITS) ❑ CESSPOOLS VALIDATI0V,-1 ROBERT A WOOD CK M oI cAcns/) SUPERVISING MECHANICAL ENGINEER L 9 9 1 4 SEP 6 1 0 D 7.0 Q- V r� 76A642D -62 APPLICATION FOR PERMIT , COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING b �-/ JOHN A. LAMBIE, County Engineer ADDRESS iJfS_or wof WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO F L 3N `ROSS ST LEGAL m AA P Me e A C/14 }A DESCRIPTION LOT N OWNER ,J (,r V MAIL O 11-TV � )��s*/ BLOCK TRACT (/ADDRESS �,f�' NO OF BLOGS / SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY PG CONTRACTOR T a r -� �; ADDRESS402F CONNECTION DATA CITYTEL NO D (.A� S ON DEPTH 1� � j STATE MANHOLE REFERENCE UPPER REGISTRATION NO /,Y `' � COUNTY NO DESCRIPTION OF WORK FEE TYPE O O E 10 LENGTH F OM HOUSE SEWER CONNECTING TO R �,(,r -L TOP L PUBLIC SEWER 55 00 SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ S1000 CO IMP NO JOB NO -7 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO R AD PERMIT NO +� PRIVATE DISPOSAL SYSTEM @ S3 00 vC CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAlvEx E�SEN[Nr RECO INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ 5500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISP SAL YS M @ $300 STATE ENCROACHMENT PERMIT NO /- INDUSTRIAL WASTE APPROVAL OWNERS PER S CHARGES �� AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE r _1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT 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 /'�/J NEW HOUSE SEWER OWNERS AGENT �� /� 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 ❑ 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 RESIDE IN THE ABO D CRIBED RESIDENTIAL PROP TY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PITS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M o CASH SUPERVISING MECHANICAL ENGINEER V 9 9 1 5'130 SEP 6 1 1 0 25.00- v