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Home My Public Portal About9686 LIVE OAK AVE_Sewer__ CESOS 3-62 76n6421) APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS �j (./�e Q�At- WILLIAM A. JENSEN, Sup't of Budding LOCALITY NEAREST OR APPLICANT TO FILL IN CROSS ST. / LEGA DESCR1PP1' N 7O NO OWNER K" QTR CT J O ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY - TEL. NO. USE OF ... .. - BUILDINGS //�� DISTRICT NO. GROUP, MAP PROCESSED/J BY IG CONTRACTOR ' / el -e / `o�`�/F �� /� BK'' d, ADDRESS q�� -c�I l•- ^ " CONNECTION DATA (. CITY �/yfD/'� TEL. NO. ION �r DEPTH t 77 (� ATEMANHOLE REFERENCE PPER R E G I ST R AT IO N'NO. v C �/ E) COUNTY .. NO. DESCRIPTION`OF WORK FEE E OF C 'EC _ LENGTH FRO HOUSE SEWER CONNECTING TO -! /YA'� Y. U P M.L.TO P.L. J > PUBLIC SEWER @ $5.00 l ,l• - O SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS ANO/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. ry /� U HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 (�/ )} (,/ CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER I EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL,DRYWELL.MANHOLE @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING +v SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT sL PERMIT NO. INDUSTRIAL V( STE APPZ AL CHARGES OWNERS PERMIT S 2 00 AUTHORIZATION TOTAL FEE (T CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONN �TaHE ABOVE DE IBED EXISTING DWELLING TO THE PUBLIC SE O APPROVALS DATE INSPECTORS SIGNAT✓ E SIGNED THIS DAY OF I, OWNER OR NEW HOUSE SEWER ;�'' �''{,rt; y -,�;�-1✓ OWNERS AGENT �41CONNECT ADDITIONAL I r ADDRESS 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 ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTER AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COU TY A TATE OF SEWAGE DISPOSAL SYSTEM :CALIFORNIA OR THAT I AM THE LE L OW E OF, D INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABOVED S IB REST AL ERTY. ABANDON HOUSE SEWER SIGNATURE BACK OF PERMITTEE EP.PIT(S) 99 LI17ATION ROBERT A. WOOD ./ M.O. CASH SUPERVISING MECHANICAL ENGINEER LAC0 3 7 8 8 m SEP 4 1 0 D 7.00- a CEBOB3-62 APPLICATION76A642D FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION 7NEAREST / d e 4a 1- JOHN A. LAMBIE, County Engineer �'WILLIAM A. JENSEN, Sup't of Building l^ Y- � vFOR APPLICANT TO FILL IN . Ei1 LEGAL 9 DESCRIPTION LOT NO.el- I/��t �/ D` WNERMA IL G B CAV "TR C .QS' Q N 3 ADDRESS RA/y.� p� NO. OF SLOGS. F AF 90er NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GRO MAP PROCESSED BY /f `S PG CONTRACTO /� / / ^ �' K `J ADDRESS � - . k CONNECTION DATA CITY �' '(/ TEL. NO. , '(p O'D S A ION DEPTHAl C'= 2 ❑ COUNTY MANHOLE REFERENCE i Ute....... REGISTRATION NO. -.r---t NO. DESCRIPTION OF WORK FEE YPE OF ON N LENGTH OM �+ HOUSE SEWER CONNECTING TO .L. M.L.TO P L. o PUBLIC SEWER @ 55.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR V PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. / ///�� HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. C ,{� O PRIVATE DISPOSAL SYSTEM @ $3.00 ,J � CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD,INSTR,NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MAN HO LE @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING _ SEWER OR DISPOSAL Y TEM @ S3.00 STATE ENCROACHMENT c PERMIT NO. Z o INDUSTRIAL WASTE APPROVAL C ONNHARGES OWNERS PERMIT $ CECTION CHARGE FEE AUTHORIZATION TOTAL FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED XISTING DWELLING TO THE PUBLIC SE / APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF v 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) 1 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 ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTER DOR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED -BY LOS ANGLES COUNTY A ATE OF SEWAGE DISPOSAL SYSTEM ' CALIFORNIA OR THAT I THE EGAL OW ER A D NTEND T DISCONNECT PLUG AND RESIDE IN, THE ABO D U RESID TI P ERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ IDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER M.O. CASH LA 3 7 8 9% SEP 4 1 1 D 2 5.00- c' 76A 6420 CEBO$� 1`71 ` 1•. APPLOCA II°OOIC FOR PfdRMOT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER GG BUILDING AND SAFETY DIVISION AooaEss �1 Q 1416-:7 LOCALITY r FOR APPLICANT TO FILL IN CROSS55T. LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACTl/YV ADDRESS NO. OF BLDGS. �� 4 L. NO. �Y v SIZE OF LOT NOW ON LOT CITY USE OF f'�1 BUILDINGS �� 'v v� DISTRICT N0. GROUPMAP PRO SED BY _ K PSS CONTRACTOR )-6) ADDRESS CONNECTION DAT CITY TEL. NO. STATION DEPTH STATE LIC UPPER LICENSE NO: CLASS MAN LE REFERENCE LOWER NO. .DESCRIPTION OF WORK FEE TYNE 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 @ $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT O. ROAD PERMIT NO. p}„ PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL AFFIDAVIT WAIVER SEMERr RECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 U OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN.,CESSPOOL.DR YW ELL. @ $5.00OR ST.WIDENING ` O HWY.ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT W MANHOLE PERMIT NO. C 0 $7.00 N INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 31 00 CHARGES AUTHORIZATION I 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 SEWER. APPROVALS ALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF OWNER OR = q �-� /�' NEW HOUSE SEWER ` OWNERS AGENT �(��fiC-,l�f�/ _ y/-I �'>^ 6/�/A,�� CONNECT ADDITIONAL ADDRESS/4K&14: ��l/I`/ 4 � �� BUILDING OR WORK SEPTIC TANK.SEEP.PIT(S) 1 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 ❑ DRVWELL ❑ 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 THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE BOV ESCRIBED RESIDENTIAL PRO ERTY. ABANDON HOUSE SEWER SIGNATURE - BACKFILL SEPTIC TANKS ❑ OF PERMfTTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ _ VALIDATIONCK.' M,.O. CASH t p