Loading...
HomeMy Public PortalAbout9702 LIVE OAK AVE_Sewer__ TEMPLE CHT 78A842D • ll° P P U CC�/a° M iN FOR P E R�ll/ T CE809 8.59 COUNTY OF LOS ANGELES SEWER—SEWAGE MSPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS v CASSATT D. GRIFFIN, Supt of Building a LOCALITY NEAREST 7/ /� A FOR APPLICANT TO FILL IN CROSS ST. /-7 �1 y� Er—m AIV- LEGAL � LEGAL DESCRIPTION LOT NO. ,P OWNER BLOCK TRACT ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF ..,i. _ ..n c ; BUILDINGS DISTRICT NO.I GROUP MAP FROCESSED BY BK G CONTRACTOR f -5 0 :a ADDRESS CONNECTION D TA a CITY 'I-)— TEL.NO. & 0� v ION / DEPTH STATE S1 REGISTRATION NO. / ® / ® COUNTY s MANHOLE REFERENCE UPPER © NO. DESCRIPTION OF WORK FEE n HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 rIv TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 h CO.IMP. NO. C! CL+ JOB NO. CONNE,y WORK TO HOUSER ISEWEBLDG.OR @ $1.00 (1 TRUNK PERMIT NO. 'ROAD PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL - WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE ,/a a i. I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TOTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING' DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ © NEW HOUSE SEWER I'IZ t9' 4F�1/ OWNER OR CONNECT ADDITIONAL OWNERS AGENT - - BUILDING OR WORK ADDRESS a SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 4' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I PLUMBING AND SEWERS. EE ALTER,REPAIR,SEWER OR tf 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND r, 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 RESIDE TIA PROPERTY. BACKFILL SEPTIC TANKS ❑ . SEEP. PIT(S) CESSPOOLS SIGNATURE ❑ ' OF PERMITTEE m VALIDATIOI$1 ROBERT A. WOOD CIL X.D• CASH✓J SUPERVISING MECHANICAL ENGINEER (�"Iwo 0 9 5 5 JAN 5.0 0 t ► 'IT 7689429 A P P U�M/ T M T FOR II E R MT " CE908 8-99 COUNTY OF LOS ANGELES SEWER—SEWAGE ®9SPOSAL DEPARTMENT OF COUNTY ENGINEER a n 4 BUILDING AND SAFETY DIVISION FADNG '70� S JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Sup't of Building TY /�A� pT / /YI/7NFOR APPLI ANT TO FILL IN. ST. LEGAL DESCRIPTION LOT NO. OWNER Y BLOCK - TRACT MAIL ADDRESS. 0.OF BLDGS. SIZE OF LOT - NOW ON LOT CITY TEL. NO. USE OF . .a..,. ;rr BUILDINGS DISTRICT NO. GROUP MAP PROCESS BY !41I BK PG I CONTRACTOR ¢ � i') R a.. ADDRESS CONNECTION(J D TA Ii CITY -- TEL.NO.A 57 ION DEPTH ElSTATE MANHOLE:RE ERENCE REGISTRATION NO. , q✓/ PPE ❑ COUNTY �J a NO. DESCRIPTION OF WORK FEE -- HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 Q TYPE OF CONNECTION - LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO.P.L. PITS AND/OR DRAINFIELD @ $3.00 OEXTN..CESSPOOL. DRYWELL 47 VERFLOW SEEPAGE PIT,DRAINFIELDs� 's¢ @ $2.00 A HOUSE SEWER CONNECTING TO P.C.NO. b PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP,NO. /" (/ JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. - ROAD PERMIT NO. WORK TO HOUSE SEWER @ $1.00 ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER 0 'DISPOSAL SYSTEM @ $1.00 , PERMIT N0. INDUSTRIAL WASTE APPROVAL 4 CHARGES OWNER'S PERMIT $ CONNECTION CHARGE FEE f. AUTHORIZATION TOTAL FEE - 4' {r' REIMBURSEMENT FEE TRHAVE AT ACTOR TO CONNECT T THE ABOVE DESCRIBED EXISTS DATE A CONTRACT WITH-THE IINGpDWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. - SIGNED THIS DAY 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT r BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) ADDRESS - AND/OR DRAINFIELD I HEREBY 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 SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY OS ANGELES COUNTY AND STATE OF T ABANDON HOUSE SEWER ' CALIFORNIA OR THAT A THE LEGAL OWNER OF THE ABOVE (; DESCRIBED RESIDENTI P PER7Y. BACKFILL SEPTIC TANKS ❑ +' SIGNATURE _ SEEP.PIT(S) ❑ CESSPOOLS ❑ OF PERMITTEE 67 - _ ®F VALIDATION ROBERT A. WOOD -. CK, M.G• CASH SUPERVISING MECHANICAL ENGINEER /'�'` '�' y�yrL✓