HomeMy Public PortalAbout10424 LIVE OAK AVE_Sewer__ CE808 3-61
78A642D APPLICATMN R W
COUNTY OF LOS ANGELES SEWER-SEWAGE ®OSP®SAL
DEPARTMENT OF COUNTY ENGUJBER
BUILDING AND SAFETY DIVISIbN BUILDING
JOHNA, LAIVIDIE, County Engineer
ADDRESS Ac �M; C� ® •
WILLIAM A. JENSEN, Supt of Building 06, LOCALITY rIrl
te'd'•
FOR APPLICANT TO FII1. IN f
CROSS ST. IV'
LEGAL OWNER V Ilf117
G
DESCRIPTION LOT N0. 10
BLOCK TACT MAIL !+C r
ADDRESS
t
v 1009k
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY !Gc TEL. NO
USE OF
BUILDINGS FR DISTRICT NO. GRO MAP P OCESSED~
gK P8
CONTRACTOR /
ADDRESS/e CONNECTION ATA
7-
CITY,/,,,VEL.N0. ` ION DEPTH
^� 'y ., ❑ STATE MANHOLE REFERENCE
REGISTRATION NO. ` / �❑ COUNTY LO R
NO. DESCRIP 10 OF FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S3.00 ov TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD >'
EXTN CESSPOOL DRYWELL @ 52.00 d
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO IMP N0. 1 4 JOB NO. U
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. ix
WORK TO HOUSE SEWER S1 00
ALTER,R DISPOSAL SYSTEN HOUSE @ $1.00 STATE ENCROACHMENT 0
SEWRPERMIT NO V
INDUSTRIAL a-
d
WASTE APPROVAL N
CHARGES z
OWM'S PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
HAVE AT T CON-
ACTOR TO CIONNECT THE ABOVA CONTRACT ES BED EXISTING NGEIN AD EDLLING APPROVAM DATE INSPECTOR'S SIO AT RE
TO THE PUBLIC SEWER. ) e s
SIGNED THIS D OF 19- NEW HOUSE SEWEROWNER OR / f�9tJa
OWNERS AGENT CONNECT ADDITIONAL f `
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I
HVfBY ACKN04LEDGE THAT t HAVE READ THIS APPLICATION
A DOSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEIj
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CO Y AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM E LEGAL R OF THE eBOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTIAL ERTY.
SIGNATURE SE.Ep PITS CESSPOOLS
OF PERMITT
MMATION OBERT A. WOOD
eS H.o, CASH SUPERVISING MECHANICAL ENGINEER
6744 % JAN 5 � G p 5.d0 r
s
CE808 3-61
7 fiA 642 D
COUNTY OF LOS ANGELES SEWER-SEWAGE ®ISP®SAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS �
WILLIAM A. JENSEN, Supt of Building LOCALITY Ifj
NEAREST
FOR APPLICANT TO FILL IN
CROSS ST.
LEGAL
DESCRIPTION LOT NO��,ZCI,, OWNER L
BLOCK TRACT NAIL
ADDRESS
140.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF ° - t ]-J�
BUILDINGS DISTRICT NO. G MAP PROCESS BY
BK PG
CONTRACTOR e �d
ADDRESS �/� O CTION DATA
CITY �r TEL.NO. �� �✓�� r S DEPTH
ON /
REGISTRATION NO. J �^ LB STATE MANHOLE REFERENCE
COUNTY' LO ER
N0. DESCRIPTION OF _ FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $8.00 TYPE OF CONNECTION LENGTH FRM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD $8.00
OVERFLOW SEEPAGE PIT,DRAINFIELD >-
EXTN. CESSPOOL DRYWELL @ 52.00 0-
HOUSE SEWER CONNECTING TO C.NO. O
REGISTRATION
DISPOSAL SYSTEM @ $1.00 CO IMP. NO. JOB NO. U
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ St 00
SEWER REPAIRO R ABANDON HOUSE L SYSTEM @ $1 00 STATE ENCROACHMENT 0
PERMIT NO. V
INDUSTRIAL lL
a
WASTE APPROVAL N
CHARGES ?
R OV;MRS PERb= $ CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
IHAVE AT THIS THE HEREIN NAMED CN-
TRACTOR TO CONNECT THE AB VE A CONTRAWIT RIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS OR 19- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADORES SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I H EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE
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 I AM TH9_,tI!nL OW HE ABOVE
DESCRIBED RESIDENTIAL PR Y. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) [:] CESSPOOLS
OF PERMIT
AIMATION ROB RT A. WOOD
cK
M.o. CASH SUPERVISING MECHANICAL ENGINEER
0 6 7 4 5 0 JAN 51 1; D 2 5.0 0