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HomeMy Public PortalAbout10534 KEY WEST ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAMFOX, COUNTY ENINEER BUILDING I CAS9ATT D.. G GRIFFIN, SuP•7 aF BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY �LA�i? r BUILDING NEAREST f Y J ADDRESS �j, CROSS ST (�( P (J! LOCALITY DISTRICT NO SERIAL NO" PERMIT NO. A 2�-.� S NEAREST r CROSS ST RECEIVED BY Ready for Inspection �} DATEISSUED OWNER '� ," rin rn /J,_" MAIL ADDRESS USE ZONE OCCUPANCYBK.MAP � CITY TEL NO CONTRACTOR CHARGES REIIYt URSEMENT FEE ADDRESS ��/ s1 . , 1+ - (% REQUIRED a NOT REQUIRE _ CITY '4", TEL NO JOB N STATE , ` t CON CTION C RGE FEE REGISTRATION NO -7 g4 r COUNTY CO IMP NO�� 1^7.. i LEGAL RECEIPT NO DATE BY DESCRIPTION LOT NO BLOCK - TRACT yLWAIVEReFOR-RECO DR ING SIZE OF LOT N0W ON LOTS �J RECEI�, DATES I BY USE OF L -/ BUILDINGS kpayf,.ATRUNK PERMIT NO NO. -DESCRIPTION OF WORK PIE E PHOUSE SEWER UBS C SEWER CONNECTING TO ; 3.50 5 (�' ROAD PERMIT NO. HOUSE SEWER CONNECTING TO STATE ENCROACHMENT -� PRIVATE DISPOSAL SYSTEM 1 00 I PERMIT NO CONNECT ADDITIONAL BLDG.OR INDUSTRIAL WORK TO HOUSE SEWER 1.00 WASTE APPROVAL ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 I U CONNECTION DATA DISCONNECT AND AND OR DISPOSAL SN SEWER SYSTEM 1 00 I STATION / DEPTH SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 I MANHOLE REFERENC�,a, G �� tV UPPER CESSPOOL—DRYWELL COWER SPECIAL CONDITIONS ONLY 200 I TYPE OF CONNECTIOA LENGTH FROM s -`g..--- CURB �P`L_ ' M L TO P L OWNERS PERMIT S I I oo AUTHORIZATION I TOTAL FEE .5'D IHAVE THIS DATE CONTRACAED CONTRACTOR TO CONNECT THE TED �DESTHE WITH RIBEDI EXIISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWE SIGNED THIS_. DAY - I NEW HOUSE SEWER 3/13h OWNER OR CONNECT ADDITIONAL ✓ M OWNERS AGENT BUILDING OR WORK (� _.. SEPTIC TANK,SEEP.PIT(S) ADDRESS/-Q�3L lU .-_ AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE AT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL❑ CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEW ER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE ESCRIBED RESI NTIAL PROPERTY BACKFILL SEPTIC TANKS SIGNATURE SEEP PIT(S)Ej CESSPOOLS OF PERMITTEE 7GA642D 663 12/52 GA64 ,D.82 78A842D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADORESS ING JOHN A. LAMBIE, County Ea 00I /©;6_37 _4 WILLIAM A. JENSEN, Sup't of Buildmg ITYSTFOR APPLICANT T , FILL IN ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT 90 ADDRESS le 3 NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS ,CONTRACTOR /. YAO T /BK 07 ADDRESS 5,16 `'4 CY .5 f C//O/^N/NECTION DATA CITY W, TEL NO C.�y� STATION . D' !� DEPTH ATE MANHOLE REFERENCE a JJD UPPER REGISTRATION NO / COUNTY / NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH ROM 91- HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L O PUBLIC SEWER ^� $5 00 C NO SEPTIC TANK SEEPAGE PIT OR a J PITS AND�OR DRAINFIELD Qp $1000 CO IMP NO OB NO HOUSE SEWER CONNECTING TO TRUN P MIT NO /t-9 OAD PERMIT NO �O PRIVATE DISPOSAL SYSTEM @ $300 /� �/ CONNECT ADDITIONAL BLDG OR $ AFFIDAVIT WAIVER EASE.ENT R CORD INSTR NO - DATE LU TO HOUSE SEWER @ $300 >a O 6 0- OVERFLOW OVERFLOW SEEPAGE PIT DRAINFIELD N EXTN CESSPOOL DRYWELL MANHOLE @ $500 HWY OR ST WIDENING Z ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT PERMIT NO 7 C•[ INDUSTRIAL WASTE APPROVAL -- OWNERS PERMIT 2 00 AUTHOMATION TOTAL FEE 3a CONNECTION CHARGE FEE CHARGES 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-- INSPECTORS SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR - - _ NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANKSEEP 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 THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN TH OVE ESCRIBED IDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP PIT(S) [IL CESSPOOS ❑ VALIDATION ROBERT WOOD cK M o CASH SUPERVISING MECHANICAL ENGINEER LXO 1. 3 1 0%-Q JUL 14. 1 0 D 5.0-0"