HomeMy Public PortalAbout10610 KEY WEST ST_Sewer__ Sa .6es 11.5a D APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY 7770)
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FOR APPLICANT TO FILL IN gROSS sT
LEGAL r -
-DESCRIPTION
LOT NO OWNER i
6- I Y '/t� - MAIL 3_,740 L /! C
BLOCK TRACT D
ADRESS L;V
NO OF BLDGS
SIZE OF LOT r/ �J ® NOW ON LOT CITY TEL NO
USE OF DISTRICT NO GROUP MAP
BUILDINGS _ / BK PG
CONTRACTOR �,f j �O C�/� I '36
ADDRESS , L� CONNECTION DATA
-� A�,r/(i STATION DEPTH
CITYTEL NO
MANHOLE REFERENCE J PPE R,7j
/ V 7 h ® I
REGISTRATION NO C3 STATE
a /
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 50 L/ - M L TOP L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD P C NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO /3a.� 10B NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 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 L REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED APPROVALS DATE INSPECTOR SISIGNATURE
CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED XISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER •"
SIGNED THIS D Y- 19 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNT ND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THF LE OWNE OF THE ABOVE
DESCRIBED I T ^P OPERYY BACKFILL SEPTIC TANKS El
SIGNATUR SE P PITS) ❑ CESSPOOLS El r
OF PERMIT
JOHN A LrB1 , COUNTY ENGINEER �T,ALIDATION ROBERT A WOOD, CHIEF PLBG INSPE TOR
K Y 0 CASH
M 1 O 3 2 °'AUG 6 4 4.J 0
76A642D APPLICATION FOR P E R M f T �
8$E-663
BeDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE Drl'5POSAL
Deportment of County Engineer
County of Los AngelesrA
LDING /D
JOHN A LAMBIE, COUNTY ENGINEER RESS CASSATT D GRIFFIN, SUPT OF BUILDING - ALITY
FOR APPLICANT TO FILL IN Geos ST
LEGL
DESCRIPTION LOT NO .L: , l OWNER S��2i ��t_.6�=
BLOCK 1r— TRACTMAIL
ADDRESS .,v
NO OF BLDGS - NO
SIZE OF LOT NOW ON LOT CITY ` TEL NO
USE OF
BUILDINGS %'C DISTRICT N0. GROUP MAP PG
BK
CONTRACTOR r
ADDRESS 0 'fit.-- ,� s7 CONNECTION DATA
STATION 8, O DEPTH O ,
CITY �` TEL NO ) r/ 'Z MANHOLE REFERENCE/,Fj d P P E R /
1 !/ rev C If '❑ STATE CC//
REGISTRATION NO ! 7 j "4-- G.-❑–c—NT-Y
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OFC NNECTION LENGTH FROM I
PUBLIC SEWER @ $3 50 M L TOP L
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD P C NO
EXTN ,CESSPOOL,DRYWELL,MAN HOLE c@ $2 00 CO IMP NO a/ 10B NO
HOUSE SEWER CONNECTING TO J
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO CP
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
,g CHARGES
V"V J CONNECTION CHARGE FEE
OW ER'S PERMIT $
- AUTHORIZATION' TOTAL FEE 6-d REIMBURSEMENT FEE -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS AY OF 19
CONNECT ADDITIONAL ll
OWNER OR � BUILDING OR WORK ^' ,
OWNERS AGENT - SEPTIC TANK,SEEP, PITS)
ADDRESS - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ t�JJ L Y'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
lk
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
LICENSED AS REQUIRED BY LOS ANGELS OUNTY A SrtATE OF DISCONNECT PLUG AND
CALIFORNIA OR--T AT I AM THE LEG WNER THE ABOVE ABANDON HOUSE SEWER
DESCRIBED R S�IDEN AL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
EP PIT(S) ❑ CESSPOOLS
OF PERMITTEE
JOHN A LAMBIE COUNTY ENGINEER/ /'VALIDATION ROBERT A WOOD, CHIEF PLBG INS ECTOR rSCK 11 0 GASH
o C 11 0 3Vn- AL's 6 5 25.Q 0 in
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