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Home My Public Portal About10602 KEY WEST ST_Sewer__ X91! ii tI%r W liairL 76A`642D -CE808-10-71 APPLICATION FOR PERMIT / I 'fl COUNTY OF LOS ANGELES p, SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION( BUILDING ,JSIE ADDRESS � vLOCALITYNEARESTFOR APPLICANT TO FILL IN ROSS ST LEGAL }'DESCRIPTION LOT NO OWNER A / ¢MAIL BLOCK TRACT V ADDRESS �{ CNO OF BLDGSSIZE OF LOT O G I Q NOWON LOT CITY TEL NO USE OF h DISTRICT NO GROUP MAP BUILDINGS /BK PG GONTRACTOR S�✓�� / —� ADDRESS CONNECTION DATA CITYTEL NO STATION DEPTH STATE LIC UPPER LICENSE NO CLASS MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL M L TO P L PUBLIC SEWER @ $7 00 C NO SEPTIC LANK SEEPAGE PIT OR JOB NO PITS AND/OR DRAINFIELD @ E10 00 CO IMP NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d PRIVATE DISPOSAL SYSTEM @ 3300 _ O CONNECT ADDITIONAL AFFIDAVIT w�IvfR e�sfr[NT RECORD INSTR NO DATE 0 WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD OC EXTN CESSPOOL DRYWELL @ $5 00 O ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING 7 SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT v W MANHOLE $7 OO PERMIT NO d INDUSTRIAL N WASTE APPROVAL CHARGES OWNER'S PERMIT $ 3 00 AUTHORIZATION TOTAL FEE h 0 CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBE EXISTING DWELLING TO THE PUBLIC SEWER � APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF �+'j19� OWNER OR NEW HOUSE SEWER OWNERS AGENT ( CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT 1 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 ❑ 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 D ISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE ESCRIBED RESIDENTIAL PROP RTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS 13OF PERMITTEE "W� SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK M O CASH 6 5 5 igov 7 1 0 0 6.0 0 A98 '7GA6'A2D APPL.ICATIONI F'OR PERMIT 1 6&E 1663 12 54 WMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL it Department of County Engineer // \J County Of LOB Angeles BU'LUILDING Vtn O- �� l\tkA� ti WM. J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST �7 {� CROSS ST: DESS RAPTION LOT NO _� t l� bb 1 OWNER �J BLOCK TRACTi �,�'J b MAIL { r S ADDRESS SIZE OF LOT { /�I k4�I NOW ONBLOTCITY TEL NO USE OF 11 comma= BUILDINGS DISTRICT NO. GROUP MAP n _ BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY TEL NO STATION DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO. ❑ COUNTY UPPER LOWER TYPE OF CONNECTION LENGTH FROM NO DESCRIPTION OF WORK FEE Y ^ CURB P L M L TO P L r� HOUSE SEWER CONNECTING TO PUBLIC SEWER Q $ 3 50 HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR CO. IMP NO JOB NO _ WORK TO HOUSE SEWER 1 00 LTER OR REPAIR EXISTING / L'Q � SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMEN J! 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 ARGES - r CONNECTION CHARGE FEE OWNERS PERMIT $ 1 00 f AUTHORIZATION TOTAL FEE0 REIMBURSEMENTIFEE HAVE I DATE CTED ITH THE ERIN MED TRACTORTTOSCONNECT THEAABOVEWDESCR BEDHEXESTINGADWELL�NG APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19- NEW HOUSE SEWER OWNER OR - CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK, SEEP, PIT(S) ADDRESS - AND/OR DRAINFIELD •� I HEREBY ACKNOWLEDGE THAT 1 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 IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG PND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR TH4T I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP PIT(S) ❑ CESSPOOLS SIGNATURE OF PERMITTEE [ - WILLIAM J. FOX, COUNTY ENGINEER VALIDATION wAP-7 3 2 3 AUG 3 0- 4 2.0 0 BY BY ( DEPUTY BY BY ® DEPUTY DEPUTY