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HomeMy Public PortalAbout9704 LIVE OAK AVE_Sewer__ TEMPLE CRTY /�orrr,� ous CE808 8-S9 �. COUNTY OF LOS ANGELES SEWYER—SEWAGE © SPOS L DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Z", ILDING d%� DRESS JOHN A. I AMBIE, CountF Engineer CASSATT D. GRIFFIN, Supt of Building CALITY Mi—ZL_ a-•rAREST FOR APPLI ANT TO FILL IN ST. LEGAL r DESCRIPTION LOT NO OWNER BLOCK TRACT ADDRESS MAIL NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. i USE OF ro ' BUILDINGS DISTRICT NO. GROUP MAP PRO SSED BY `K PG CONTRACTOR yy/�- Pr ADDRESS tJ' !�/h r�/ f /-- ,� CONNECTION DATA a CITYTEL.NO. A ON DEPTH STATE ���c��/ 4 REGISTRATION NO. COUNTY MANHOLEREFERENCE' s e f NO. DESCRIPTION OF WORK FEE . HOUSE SEWER CONNECTING TO 's PUBLIC SEWER @ $3.00 V TYPE OF CONNECTION LENGTH FROM 4� SEPTIC TANK,SEEPAGE PIT OR ,J PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL,DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. 3 ® JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. J WORK TO HOUSE SEWER @ $1.00 f ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 - PERMIT NO. INDUSTRIAL WASTE APPROVAL A CHARGES OWNERS PERMIT g Z 00 P CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE /tozo �c5 p�� �yy�fSMn. 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. 11, SIGNED THIS DAY OF 19_ NEW HOUSE SEWER -4ft;, OWNER ,/�j _ ' / CONNECT ADDITIONAL OWNERS A AGENT / /r,�'"�/ BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PITS) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT .1 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 ,y ALTER,REPAIR,SEWER OR AND SEWERS. SEWAGE DISPOSAL SYSTEM 4I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR n 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 OOPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEE .PIT(S) ❑ CESSPOOLS ❑ OF PERMITTE ®" VALIDATIO ROBERT A. WOOD CIL M.0. CASH SUPERVISING MECHANICAL ENGINEER �y J� 0 9 5 7 �o JAN 1l .L li 5-.0 0- .1�L� iTEMPLE CUTY ' - COUNTY OF LOS ANGELES SEWER-SEWAGE ®O SP®S DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ® ` ke a / JOHN A. LAMBIE. County Engineer ADDRESS CASSATT D. GRIFFIN, Sup t of Building LOCALITY NEAREST - � FOR APPLICANT TO FILL INV CROSS ST. F > LEGAL DESCRIPTION LOT N0. OWNER BLOCK TRACT ADDRESS _ g NO.OF BLDGS. ' SIZE OF LOT NOW ON LOT CITY TEL. NO. �.p USE OF - s BUILDINGS DISTRICT NO.^ GROUP MAP 'P.RO ESSED BY 'a K P CONTRACTOR o� f j I •~ /'� �/ � ADDRESS `•� �� T� /r V - CONNECTIONv ATA CITY TEL.NO�®&eW&® e ION DEPTH ❑ STATE MANHOLE RE ERENCE / UPPE 11 REGISTRATION NO. p ❑ COUNTY 11 NO. . DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO - 1• PUBLIC SEWER - @ $3.00 lu 'SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION - LENGTH FROM 9 PITS AND/OR DRAINFIELD @ $3.00 a Y. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO- P.C.NO. _ 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 DISPOSALS STEM @ $1.00 PERMIT NO. '( ,s INDUSTRIAL - WASTE APPROVAL CHARGES OVMER'S PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEEA157 REIMBURSEMENT FEE NMED CON. TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDATE A CONTRACT.WITH THE ItNGADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. , SIGNED THIS DAY OF 19- NEW HOUSE SEWER u OWNER ORr CONNECT ADDITIONAL OWNERS AGENT _ - BUILDING OR WORK ADDRESS - SEPTIC TANK,SEEP.PIT(S) .AND/OR DRAINFIELD - LANDSTATE EBY ACKNOWLEDGE THAT I HAVE READ THIS. APPLICATION ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑LL COUNTY ORDINANCES AND STATE LAWS REGULATING ` ALTER,REPAIR,SEWER OR NG AND SEWERS. I SEWAGE DISPOSAL SYSTEM EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER NIA OR THAT I THE LEGAL OWNER OF THE AED RESIDENT L P OPERTY. BACKFILL SEPTICTANKS ❑URES EP.PIT(S) ❑ CESSPOOLS ❑RMITTE ®" VALIDATION ROBERT A. WOOD K. CM.0. CASH SUPERVISING MECHANICAL ENGINEER