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Home My Public Portal About10680 KEY WEST ST_Sewer__ III I 76A 642D -CE808-10-71• APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWPiPE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS (j Y �• LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST LEGAL DESCRIPTION LOT NO OWNER ,(� 311? ct MAIL BLOCK TRACT � ��Ill [ ADDRESS C ` NO OF BLDGS SIZE OF LOT 7 , NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO GROUP MAP PRO ESSED BY BUILDINGS BK PG CONTRACTOR I 3,6- ADDRESS 1 QJI . •� /�• CONNECTION DATA r v CITY �- TEL NO ��p�-7 J y. STATION X6 •S DEPTH 1�• y ' STATEVJJJ MANHOLE REFERENCE UPPER LICENSE NO, 1•^O 7 4j ASS ` 5 — NO. -DESCRIPTION OF WORK FEETYPE OF CONNECTION -LENG FROM HOUSE SEWER CONNECTING TO Y. CURB P.L.' M L.TO P L. PUBLIC SEWER @ $7.00 SEPTIC TAK SEEPAGE PIT OR P.G.NO N PITS AND/OR DRAINFIELD SI000 CO.IMP. NO. Z I JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG OR U AFFIDAVIT wMv[N -[[5[M EXT RECORD INSTR.NO. DATE O 0 WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT.DRAINFIELD O EXTN.CESSPOOL DRYWELL $500 HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ S300 STATE ENCROACHMENT W MANHOLE 0 $7.00 PERMIT NO. d INDUSTRIAL h WASTE APPROVAL Z OWNERS PERMIT s 3 00 AUTHORIZATION TOTAL FEE /00 CONNECTION CHARGE FEE CHARGES IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRIRACTOR TO CONNECT THE ABOVE DESCD EXISTING DWELLING TO THE PUBLIC SEW . 1 •� HAPPROVALS DATE INSPECTOR'S IG NATO RE SIGNED TIS DAY OF �f� 19_ OWNER OR �yNEW 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 COUNTYANDSTATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER O �..4ND INTEND TO /-///V/V/ DISCONNECT PLUG AND RESIDE IN, THE ABO E DESCRIBED RESID TIA P OPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTE SEEP IT(S) ❑ ESSPOOLS ❑ VALIDATIO CK.' M,O, CASH IN L 4 -3 4 w JAN LI. 1 0 Q 6.0,0-, I 76A 6420—CE806 —10-71 APPLICATION FOR PERM COUNTY OF LOS ANGELES SEWER-SEWAGE ISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING !/ ADDRESS /O�i ,�. LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO OF BLDG /� �j V SIZE OF LOT (6' til NOW ON LOT ✓ CITY TEL. NO. USE OF DISTRICT NO GROUP MAP P OCE SSE BY - BUILDINGS l /}�J BK PS GONTRACTOR _ J &1V< {/ y 4 -3 ADDRESS / CONNEC ON DATA CITY TEL NO �' �2 77 2 STATION v DEPTH �] STATE 13 CLASS '� 13-( MANHOLE REFERENCE / ' .ti A UPPER LICENSE NO NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FR3 X 7' HOUSE SEWER CONNECTING TO Y CURB P'L M L TO P L /Vl PUBLIC SEWER 0 $7.00 SEPTIC TANK.SEEPAGE PIT OR �� PC NO. PITS AND/OR DRAINFIELD @ $1000 CO IMP NO .108 NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM S300 TRUNK PERMIT NO. ROAD PERMIT NO d �� O CONNECT ADDITIONAL BLDG OR AFFIDAVIT I wAIY[v '[AS[M[NT RECORD INSTR NO DATE V WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD CL EXTN CESSPOOL DRYWELL. @ $500 HWY OR ST WIDENING 0 ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYS M $300 STATE ENCROACHMENT W MANHOLE $7.00 PERMIT NO h INDUSTRIAL i WASTE APPROVAL OWNERS PERMIT S 3 00 CHARGES AUTHORIZATION1 TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SE APPROVALS DATE IN TOR'S SIGNATURE SIGNED THIS DAY O 19_ OWNER OR Yf/. _ NEW HOUSE SEWER OWNERS AGEN �(j/ �{.� CONNECT ADDITIONAL ADDRESS �'-� (I� BUILDING OR WORK 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 COU TY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA ORtTHAT!12qfGAL NEF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THRE ENT L PR ERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKSOF PERMrrTE SEEP opyr(S) ❑ CESSPOOLS ❑ VALMATIO CK. M.0. CASH LACo6 725- JUN 2.9'1 0 -D 110.0:0-