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HomeMy Public PortalAbout9720 LIVE OAK AVE_Sewer__ - ' 24650 INSERTS ,/ "CES AO642D 0 7snsazn APPLICATION, -FOR PERMIT� COUNTY OF LOS ANGELES .SEWER,—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER- BUILDING BUILDING AND SAFETY DIVISION DDRES Z© ADDRESS JOI�f A. LAMBIE, Countp Engineer WWILLIAM A. JENSEN. Supt of Suildiag LOCALITY` NEAREST y ' FOR APPLICANT TO FILL CROSS ST LEGAL. ` ,OWNER07 , - , DESCRIPTION LOT N0. _ - BLOCK TRAC �(�� ,MAIL - i � ADDRESS NO OF BLDGS. - SIZE OF LOT NOW ON LOT 'CITY TEL NO USE BUILDINGS DDISTRICT N0. GROUP MAP CESSED BY LL CONTRACTOR LE : ' ADDRESS © CONNECTION DATA a CITY - TEL NO STATION r DEPT STATEMANHOLE REFERENQ� REGISTRATION NO O / NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO iv/( PUBLIC SEWER @ $3 00 C/ Lr TYPE OF TION LENGTH FROM Y SEPTIC TANK,SEEPAGE PIT OR Y. P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD ' EXTN CESSPOOL DRYWELL @ $2 00 P.C.N0. HOUSE SEWER CONNECTING TO CO IMP N0. �'� JOB NO. PRIVATE DISPOSAL SYSTEM @ $t 00 CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0. 3 0 WORK TO HOUSE SEWER @ $100 U ALTER,REPAIR O R ABANDON SYSTEM HOUSE @ $1 00 �' STATE ENCROACHMENT P4 SEWERPERMIT NO 0 `INDUSTRIAL U d..WASTE APPROVAL W CHARGES N •OWNER'S PERMIT $ 1 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EypISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER r / ' SIGNED THIS DAY OF 19�L NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL ' OWNERS AGENT __ � BUILDING OR WORK - ADDRESS SEPTIC TANK,SEEP.PIT(S) - AND/OR DRAINFIELD LDESCRIBED HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - - - - STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ ' ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR MBING AND SEWERS - SEWAGE DISPOSAL SYSTEM HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND NSED AS REQUIRED' BY LOS ANGELES COUNTY AND STATE'OF AgANDON'HOUSE SEWER - �• "' FORNIA OR THAT I AM THE LEGAL OWNER 0 THE ABOVE RESIDENTIAL PROPERTY- - BACKFILL SEPTIC TANKS ❑ ATURE SEEP.PIT(S) ❑ CESSPOOLS ❑ _ PERMITTE ' fw ®P ALIDATION .� ROBERT A. WOOD w� `-'-`--'` "suPERVISING:MECHANICAL=EIVblNEER + • "1 �• CIL SEI.0. CASH �. - �;€;y`; 0 , sty 2 5 76A6420 APPLICATION FOR P&M11' 1 S R E-663 12.34 �11� DIYLSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of LOB Angeles BUILDING WM.J. FOX, COUNTY ENGINEER ADDRESS ' - CASSATT D.GRIFFIN,SUPT oP BUILDING LOCALITY FOR APPLICANT TO FILL INNEAREST LEGAL CROSS ST. •/1J /J/�= `���'�'� /� DESCRIPTION LOT NOWNER BLOCK TRACT 9�� r� MAIL ADDRESS NO. OF BLDGS. SIZE OF LOT "d NOW ON LOT CITY EL NO. USE OF BUILDINGS DISTRICT NO. I P ROUP MAP CONTRACTOR47 U BK ADDRESS �yzz CONNECTION DATA CITY Ll9L%`JIT!DIS//�/Y TEL. N AV _� j�y STATION DEPTH [ STATE MANHOLE REFERENCE REGISTRATION NO. ❑ COUNTY UPPER LOWER TYPE OF CON CTION LENGT ROM NO DESCRIPTION OF WORK FEE Y. CURB P L. M L P L HOUSE SEWER CONNECTING TO PUBLIC SEWER Q $ 3 50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR CO. IMP. NO. JOB NO WORK TO HOUSE SEWER 1 00 / ALTER OR REPAIR EXISTING —t'- SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. D PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK,SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES OWNER'S PERMIT $ t 00 CONNECTI CHARGE FEE AUTHORIZATION -TOTAL FEE OO REIMBURSEMENT FEE TRACTORHAVE T TO CONNECT THEHIS DATE AABODVE DESCRIBED THE H ESCRBEDHEREXISTINGA DWELLING APPROVALS D4TE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER - SIGNED THIS DAY OF 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL - - OWNERS AGENT BUILDING OR WORK SEPTIC TANK, SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[:1DRYWELL❑ AND-STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR _ PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 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 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ElSEEP. PIT(S)_❑ CESSPOOLS❑ SIGNATURE I , OF PERMITTEE f ffm3m gal—. WILLIAM J. FOX, COUNTY ENGINEER VALIDATION BY , ' Aol'8 g,:319•., 22 4� 2:U Q DEPUTY ~ <] DEPUTY �.z 06 BY BY -® DEPUTY DEPUTY