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Home My Public Portal About10422 LIVE OAK AVE_Sewer__ -6, 76A6423-61 APPLICATION FOR PERMIT 78A 642 COUNTY OF LOS ANGELES SEWER-SEWAGE ®QSPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /�,( ADDRESS (/ JOHN A, LAMBIE, County Engineer r WILLIAM A. JENSEN, Supt of Building_ LOCALITY NEAREST FOR APPLICANT TO FILL CROSS ST. ` LEGAL _ DESCRIPTION LOT NO - OWNER F BLOCK TRACT MAIL ADDRESS N0.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO USE OF77� BUILDINGS DISTRICT N0. GROUPI MAP P O(ESSED BY Ar PG CONTRACTOR . � I v /) / ADDRESS CO/LNNECTION DATA CITY TEL.N0. 6-11/ j— S N DEPTH STATE MANHOLE REFERENCE REGISTRATION NO. a COUNTY OWER NO. DESCRIPTION OF WOPX FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $9.00 TYPE OF CONNECTION LENGTH FROM SEPTIC DgNK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD $9.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN. CESSPOOL DRYWELL @ S2.00 _ d HOUSE SEWER CONNECTING TON0. Q PRIVATE DISPOSAL SYSTEM @ $1.00 CO IMP. NO. JOB C.NO. V CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER $1 00 ALTER,REPAIR OR ABANDON HOUSE - STATE ENCROACHMENT SEWER DISPO AL S @ $1.00 PERMIT N0. INDUSTRIAL WASTE APPROVAL N CHARGES z Qy 'R�g PERMIT $ - CONNECTION CHARGE FEE AUTIiORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THEA DESCRIBED EXISTING DWELLING APPRO` MS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THI DAY OR 19_ [AND/OR W HOUSE SEWER OWNER OR NNECT ADDITIONAL OWNERS AG ILDING OR WORK ADORE PTIC TANK,SEEP.PIT(S) DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYSSPOOL ❑ DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEII 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGI STE D AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY A STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM TH��eEBAL 0 R THE A$OVE DESCRIBED RESIDENTIAL PRO RTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP PITS CESSPOOLS OF PERMITTE ' ATION ROBERT A. WOOD n.o. CASH SUPERVISING MECHANICAL ENGINEER , � 67431% JAN 5 ? 1 D 25,0C) V CE808 APPLICATION FOR PERMOT 78A 642DD COUNTY OF LOS ANGELES SEWER-SEWAGE ®BSPOSAL DEPARTMENT OF COUNTY ENGINEER ,.,, BUILDING AND SAFETY DIVISION rBUIL DINGESS { 7 JOHN A, LAMBIE. County EngineerWILLIAM A. JENSEN, Supt of Building LITY L' ACFOR APPLI ANT TO FELLLEGAL s Ssr. �+ F DESCRIPTION I -JON LOT NO OWNER a G BLOCK TRACT MAILc / ADDRESS` r �'r� C. i N0.OF BLDGS, _/� -SIZE OF LOT NOW ON LOT CITY C l G r EL. NO USE OF BUILDINGS P6 DISTRICT NO.'( GROU B MAP PROCESSED BY CONTRACTOR ,-,i ADDRES CONNE TION DATA CITY TEL.WO. ST TI DEPTH /J /� STATE MANHOLE REFERENCE REGISTRATION NO. L[ 1. COUNTY / < 6 LOWER NO. DESCRIPTION OF _ FEE` �r HOUSE SEWER CONNECTING TO @ $9.00 `7 SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AMD/OR DRAINFIELD 39.00 Y. URB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN CESSPOOL DRYWELL @ $2.00 C HOUSE SEWER CONNECTING TO jP C.NO. O PRIVATE DISPOSAL SYSTEM @ SLOO CO IMP, NO. JOB N0. V i 'y CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER Si 00 � SEWER R DIISPOSAL S'AYSTEM HOUSE @ $1 00 STATE ENCROACHMENT O PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES z OWNEWS PT S Z ER00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACTWITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABO DESCRIBED EXISTING DWELLING APPROVAM DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. I _ _ SIGNED THIS TDAY OF. NEW HOUSE SEWEROWNER OR OWNERS AGE CONNECT ADDITIONAL r / BUILDING OR WORK ADORES [i' 4 SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD IEBY CKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION- ANels ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL WILL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR _ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTE LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM TIM LEGAL OF TH§ ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL BACKFILL SEPTIC TANKS ❑ SIGNATURE SEP.PJT( CESSPOOLS El OF PERM E �-� ALIDATION ROBERT A. WOOD cK. 5.0. CASH t�S,UPERVISING MECHANICAL ENGINEER sr, C.tt.Jr "F �O �trUN 51 0 t)