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Home My Public Portal About10686 KEY WEST ST_Sewer__ 76A 642D -CE808 -10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER r BUILDING,AND SAFETY DIVISION BUILDING .CJy� , ADDRESS / LOCALITY NEq REST FOR APPLICANT TO FILL IN =ROSS 5T T, rt� / LEGAL DESCRIPTION LOT NO OWNER /�yq� MAIL BLOCK TRACT \�) /- 1 ) 31 ADDRESS y' /�/ NO OF BLOGS ��• SIZE OF LOT 6 /� ! J NOW ON LOT CITY TEL NO. USE OF BUILDINGS � � •'cR DIS TRICT NO GROUP MAP PS PROCESSED BY _ J ,CONTRACTOR .� 4L `� �I w � ADDRESS : -3 CONNECTION DATA } STATIO � DEPTH CITY /��/ /..Z TEL NO k,. STATE /�yy LIC /F MANHOLE REFERENCE y UPPER LICENSE NO. V�� CLASS ~�( tt 7 / L � NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO `, G CURB P:L. M L.TO P L. PUBLIC SEWER @ $7.00 2 L/ PC NO.' - SEPTIC TANK.SEEPAGE PIT OR CO IMP. NO. JOB NO PITS AND/OR DRAINFIELD ® $10 00 HOUSE SEWER CONNECTING 70 TRUNK PERMIT NO ROAD PERMIT NO. * 5n. PRIVATE DISPOSAL SYSTEM $3 00 J CONNECT ADDITIONAL BLDG OR - AFFIDAVIT O WORK TO HOUSE SEWER @ $3 00 wAIY[[ TA5[Y[NT RECORD INSTR NO DAT 0 - OVERFLOW SEEPAGE PIT DRAINFIELD .EXTN CESSPOOL ORYWELL,' @ $500 HWY OR ST WIDENING O ALTER REPAIR OR ABANDON HOUSE I— 'SEWER OR-DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT W .MANHOLE $7.00 PERMIT NO d N INDUSTRIAL WASTE APPROVAL Z OWR NES PERMIT s 3 00 CHARGES AUT HORIZATION1 TOTAL FEE 4,0 v CONNECTION CHARGE FEE 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 SE n APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 194 OWNER OR } NEW HOUSE SEWER - OWNERS AGENT L- 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 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 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 AB DESCRIBED RESID TIAL ROPER Y ABANDO HOUSE SEWER SIGNATURE / BACKFI L EPTIC TANKS ❑ OF PERMTTT2£ SEEP.P T( ) SSPOOLS OF VALIDATION CK. M•.0. CASH 1 a D 1 0.0 0,Y cv 76A 6%,2D-CE808 -10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �O / `! ADDRESS t0 a r LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO OWNER (/q MAIL � l� BLOCK lTRACT 4 C- � � -3I { � ADDRESS 7? SIZE OF LOT �(� /� ! ,J NOWOON LOTBILD S CITY TEL. NO. USE OF BUILDINGS DISTRICT NO GROUP MAP ESSED BY BK PG CONTRACTOR ADDRESS e).Z , /CONNECTION DATA CITY TEL NO STATION �N DEPTH ✓ STATE /� LIC J.� / MANHOLE REFERENCES / UPPER LICENSE NO. (/ G I GLA55(f " tgy{6p� NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P.L M L TO P L. PUBLIC SEWER @ $7.00 P C NO. SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD SIO 00 CO IMP NO. JOB NO- HOUSE ' HOUSE SEWER CONNECTING TO - TRUNK PERMIT NO ROAD PERMIT NOIJ 35 d PRIVATE DISPOSAL SYSTEM @ S300 ll O CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER "EASEMENT RECORD INSTR NO DATE u WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT.DRAINFIELD OC EXTN CESSPOOL DRYWELL, $500 O ALTER.REPAIR OR ABANDON HOUSE HWY OR ST WIDENING V SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENTNJ PERMIT NO d MANHOLE ® $7.00 INDUSTRIAL h WASTE APPROVAL '4t 0,-J-L OWNERS PERMIT s CHARGES AUTHORIZATIONJ TOTAL FEE ,O 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�y Ew-- APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS SE OF 1� OWNER OR 'v✓_` NEW HOUSE SEWER OWNERS AGENT �/y CONNECT ADDITIONAL ADDRESS ✓J I_ � � 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 ❑ IHEREBY 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 OW R O AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE AB ESCR ED REST 1 R Y ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANK ❑ OF PERMTTTE SEEP.PIT(S) ❑ S )DOLS ❑ VALIDATION CK. O. CASH IM Lo �? 3WJ 1611D 30.00M 76A 642D-CE808 -10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SE GE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /� ADDRESS LOCALITY s NEAREST FOR APPLICANT TO FILL IN CROSS ST. / /!✓[. gBY LEGAL DESCRIPTION LOT NO OWNER —M 3 1 9 MAIL BLOGK TRACT j j � ADDRESS NOOF BLDGS. SIZE OF LOT /\ NOW ON LOT CITY TEL. NO. USE OF ABUILDINGS DISTRICTNO GROUP MAP P BK p3 - CONTRACTOR (�I�'` •-�� y /l . ADDRESS �• L- , CONNECTION DATA / STATION /'�' L +� CITY JJTEL. NO S2-7-7-2- STATE Z / 57-DEPTH / LICENSE NO -2 S7- C GLASS Ifw' r Q � ��) �7•d/ UPPER t�glpR G MAfy OLE RE ERE CE No. DESCRIPTION OF WORK FEE ` TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y P.L M L.TO P.L. PUBLIC SEWER 0 $7.00 Q� . t0 C NO. SEPTIC TANK SEEPAGE PIT OR J PITS AND/OR DRAINFIELD @ 31000 - L' OB NO. HOUSE SEWER CONNECTING TO , PRIVATE DISPOSAL SYSTEM @ $300 TRUNK PERMIT NO. 73--/ ROAD PERMIT NO. O CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER -EASEMENT RECORD INSTR NO DATE 0 WORK TO HOUSE SEWER $300 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN.CESSPOOL DRYWELL @ $S 00 HWY. OR TF WIff.DENING, ALTER REPAIR OR ABANDON HOUSE �{ �• ^ �� 1"') (,-`e^ O SEWER OR DISPOSAL SYSTEM $300L)EN RO M N, �' eta 7�t j V MANHOLE PER N j e ay -_ d 0 $7.00 . n .L■ v a w c..[� INDUSTRI L VJ WASTE A ROVAL Z OWNERS PERMIT $ 3 00 tom^ CONNECTION CHARGE FEE X e S — Jd AUTHORIZATION TOTAL FEEJjQ 73 IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEW R � APPROVALS DATE INSP E TOR'S SI NA URE SIGNED THIS_ DAY OF ��'�� 19/'j.l OWNER OR �` NEW HOUSE SEWER OWNERS AGEN CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANKSEEP.PIT ) 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 CESSPO ❑ D LL 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,R R.SE LICENSED AS REQUIRED BY LOS ANGLES COON AND STATE OF SEWA GE DISPOS S CALIFORNIA OR T 1 AM THE LEGAL OWNER , AND INTEND TO DISCONNECT P A D RESIDE IN T ABO E DES RIBED RES ENTI PRO RTY ABANDON HOU SEW SIGNATURE BACKFIL EPTIC TA KS ❑ OF PERMITTEE SEEP PI 1 ) ❑ SPOO VALIDATION CK, 0. CASH Viso �' 4 ? 9 , JAW 4 8 0 0 1 5 0.0.0- o L.,�Co rT 3 w JAN 4 1 0 0 1 0.0 0