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Home My Public Portal About9816 KEY WEST ST_Sewer__ ,76A642D APPLICATION FOR PERMIT 7 S @ E 663 12.54 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING ff WM.J. FOX, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS Sr A 4- LEGAL j w DESCRIPTION LOT NO (/ OWNER BLOCK TRACT /F e e MAIL /// ADDRESS Q0NO OF BL a U Q SIZE OF LOT d � NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT N6 V GROUP MAP BK PG CONTRACTOR ADDRESS CONNECTION DATA CIT TEL NO STATIO/N DEPTH CJ/o 0 STATE � REFERENCE ON06' CLREGISTRATINWUPER ' TYPE OF CONN TION LENGTH FROM �2 NO DESCRIPTION OF WORK FEE Y CURB) P L M L TO P L J YHOUSE SEWER CONNECTING TO t O PUBLIC SEWER Q $ 3 50 V HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR CO IMP NO /��j;� JOB NO WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING _ SEJVER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO r 2 DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT 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 CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 AUTHORIZATION TOTAL FEE 1/15-0 REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DE CRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR SSIGNATURE TO THE PUBLIC SEWER SIGNED THIS S DAY (OF j�(Qpt�� 195 NEW HOUSE SEWER 713-65 OWNER OR 1� CONNECT ADDITIONAL OWNERS AGEN / BUILDING OR WORK SEPTIC TANK, SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD fZ I HEREBY ACKNOWLEDGE TH I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[IAND STATE THAT THE ABOVE 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ C SIGNATURE SEEP PIT(S) [ICESSPOOLS Er 'S- 1�1.t.� �f OF pERMITTE 7J WILLIAM J. FOX, COUNTY ENGINEER VALIDATION BY �0 4 7 5Y 21P) tr JUN 15 4 11 4.5 a DEPUTY � DEPUTY BY BY / ® DEPUTY DEPUTY 08 C 1#642D -63 76AFB42D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNNEAREST LDING o JOHN A. LAMBIE, County Engineer RESS �J l WILLIAM A JENSEN, Sup't of Building C A L.TY (c' SSST FOR APPLICANT TO FILL IN 9' C /�- �LEGALL, L //.,� (� ^, DESCRIIPTION LOT NO 6/ OWNER L L C /1-1 /I ✓ 'a �'y BLOCK TRACT l (' ADDRMA'LESS It- NO ,j C �� OF BLDGS SIZE OF LOT 1, NOW ON LOT CITY -^� TEL NO BUELD NGS 0A/L y �/--� RA DISTRICT NO GROU MAP PROCESSE BY n I/�// f 1 •�- BK PG CONTRACTOR �� F P C K 4 ✓4�^ 1,- ✓E ADDRESS / e c" /SS/ /V ['D/ CONNECTION DATA CITY 0 01-1,o6 A� TEL NO t7 QCl d 5 STATION DEPTH /J..� I}{� STATE MANHOLE REFERENCE UPPER REGISTRATION NO • 7 tiJ IJ COUNTY LOWER 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 @ 35 00 PC NO CLO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO PITS AND/OR DRAINFIELD @ SIO 00 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO Q[ PRIVATE DISPOSAL SYSTEM @ $3 00 0 CONNECT ADDITIONAL AFFIDAVIT WAIVEN EASEMENT RECORD INSTR NO DATE I-- WORK TO HOUSE SEWER @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD LLL EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING H SEWER OR DISPOSAL SYSTEM @ $3 00 1 STATE ENCROACHMENT z PERMIT NO INDUSTRIAL OWNERS PERMIT S z oWASTE APPROVAL CHARGES 0 AUTHORIZATION TOTAL FEE 1-5-01--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 SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER A OWNERS AGENT CONNECT ADDITIONAL �~ BUILDING OR WORK •i> y� ADDRESS SEPTIC TANK SEEP PIT(S) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 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 DISPOSAL SYSTEM CALIFORNIA OR THA I AM THE EGAL OWNER OF AND NTEND TO DISCONNECT PLUG AND RESIDE IN THE A V DE I ED R IDjA 1 PROP 'Y G (/u-/j/ ABANDON HOUSE SEWER SIGNATURE n BACKFILL SEPTIC TANKS ❑ OF PERMITTEE J SEEP PIT(S) ❑ CESSPOOLS ❑ LIDATION ROBERT WOOD cK M O CASH SUPERVISING MECHANICAL ENGINEER L-ACI0 A 5 9 1'� nl;G 1 2 1 J D J D S&E-689•I1-S5 APPLICATION FOR PERMIT 1 S @ •8 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of LOS Angeles rB= J� ��S JOHN A LAMBIE, COUNTY ENGINEER !TEL /�/0 CASSATT D GRIFFIN, SUPT OF BUILDING OCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. O� Ccs7 LEGAL DE CRIPTION LOT NO �� OWNER cMAIL BLOCK TRACT 3' � ADDRESS V NO OF BLDGSCITY SIZE OF LOT NOW ON LOT USE OF _ DISTRIC� I GROUP I � MAP BUILDINGS CONTRACTO 9 ADDRESS Z � 1 ?CONNECTION DATA /2 F ' / �� o DEPTH CITY 01 L NO STATION MANHOLE REFERENCE UPPE ✓� STATE A /' WER REGISTRATION NO T j❑ COUNTY No DESCRIPTION OF WORK FEE TYPE OF CONNE T N - LENGTH FROM HOUSE SEWER CONNECTING TO y_ CURB P L M L TO P L. PUBLIC SEWER @ $3 50 SEPTIC TANK,SEEPAGE PIT OR ,ty PITS AND/OR DRAINFIELD @ $3 00 �_- OVERFLOW SEEPAGE PIT, DRAINFIELD P C NO EXTN ,CESSPOOL,DRYWELL,MANHOLE n $2 00 CO IMP NO JOB 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 @ $100 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE 1 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 SEWE NEW HOUSE SEWER �C) ✓ `-ti_ SIGNED THIS DAY O 19-4 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) ADDRESS L AND/OR DRAINFIELD I HEREBY ACKNOWLEDG 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 COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LE L 0 ER OF THE ABOVE DESCRIBED RESID TIAL ROP RTY BACKFILL SEPTIC TANKS❑ �d-e�j�� SIGNATURE SEEP PIT(S) ElCESSPOOLS-E:]CESSPOOLS- OF PERITTE JOHN A LAMBIE. COUNT NGINEER VALIDATIO ROBERT A WOOD, CHIEF PLBG INSPECTOR CK N O CASH i' 2 0 0 .Jt1PI 1-8-1 4 A 42 �0' - �