HomeMy Public PortalAbout9722 LIVE OAK AVE_Sewer__ ' 24650 INS® S®
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ES s•so AIf'"If"LICATI®ASI FOR PERMIT 1
-76AS42D COUNTY OF LOS ANGELES SEWS.{—SEWAGE DISPOSAL 1 .
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
IOI3N A. LAMBIE, County Engineer
ILLI A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cRoss sr.
LEGAL /. _
DESCRIPTION LOT N0. -� CJ OWNER '
BLOCK TRACT MAIL -
ADDRESS
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OF ,
DISTRI T NO. MAP P OCESSED BY
BUILDINGS ,,,, G 4k
CONTRACTOR _ J rBK Lj ,
ADDRESS yzo CONNECTION DATA
CITY// TEL NOO
T N DEPTH `�
STATE MANHOLE REFERENCE jT -� UPPER
• REGISTRATION NO COUNT VV LOW R
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROMSEPTIC q L '
P
ITS AND/OR'SEEPAGE DRAINFIELDT OR @ $3 00 Y. CURB P.L. M.L.TO P.L. ��,J
OVERFLOW SEEPAGE PIT, DRAINFIELD 6 ��
EXTN CESSPOOL DRYWELL @ $2 00 ,
HOUSE SEWER CONNECTING TO -P. N
PRIVATE DISPOSAL SYSTEM @ $I 00 CO IMP N0. d JOBB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. �3 O
WORK TO HOUSE SEWER @ $1 00 U
ALTER,REPAIR O R ABANDON SYSTEM HOUSE @ $1 OO r STATE ENCROACHMENT pq
SEWERPERMIT NO p
Ia. INDUSTRIAL
WASTE APPROVAL W
a
CHARGES N
OWNER'S PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE V REIMBURSEMENT FEE
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.
SIGNED THIS D 9_ NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND' AGREE TO COMPLY CESSPOOL El DRYWELL ❑ i
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY 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 F TH ABOVE
DESCRIBED RESIDENI.LLNL PROPE SEEPFILL SEPPIT ) ❑ C=OEIS ❑
SIGNATURE _
OF PERMITTEE
64 "_ -
4
OF ALMATION ROBERT A. WOOD
CK. H o CASH SUPERVISING MECHANICAL ENGINEER
( , � 3 4 1 0 2 5.0 0
'24650 INSERT
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CE80e D " A E D LI CA Y IO D�+- FOR D 9...,9 Y M I 9 �• c
78A842D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
,ADDRESS
JOIiN A. LAMBIE, County Ea neer
WILLIAM A. JENSEN, SuP't of Building LOCALITY
NEAREST
FOR APPLICANT TO IN CROSS ST.
[Ul
L 1 OWNER
TION LOT N0. A
- TRA C t '� /' t MAIL
ADDRESS - - + -
NO OF BLDGS.
LOT NOW ON LOT CITY' _ TEL N0.
DISTRICT NO. GROUP MAP, PROCESSED BY
GS �}
!J I B�� PG I
CTOR [f" '. CONNECTI DATA TEL NO STATION /st�S"'Q DEPTHSTATE MANHOLE REFERENCE �:J QATION N0. S LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 TYPE"OF CONNECTION .L.NGTH FROM �-
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. TO P.L.
PITS AND/OR DRAINFIELD @ $3 00 _
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00 _
�� d JOB NO.
u HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM _ @ $1 00 CO IMP. N0. �
WORK
CONNECT
ADDITIONALOUSE LDG OR @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO. O
U
A'TE R OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT - Al
PERMIT NO. O
INDUSTRIAL �.
i WASTE APPROVAL W '
CHARGES tn
'OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE -
AUTHORIZATION TOTAL FEE Q'0 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE,ABOVE DESCRIBED EXISTING DWELLING APPROVAL'S DATE INSPECTORS SIGNATURE
TO THE PUBLI SEWER.
[ADDRESS'
ED THI DAY OF 19- NEW HOUSE SEWER
ER OR CONNECT ADDITIONAL ,
ERS AGENT BUILDING OR WORK - -• -
SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
EREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIONSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL,❑ DRYWELL ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER ORBING AND SEWERS - " ySEWAGE DISPOSAL SYSTEMHEREBY CERTIFY THAT I AM PROPER L•YSREGISTERED AND/OR DISCONNECT PLUG AND-NSED AS REQUIRED BY LOS ANGEL'ES-COUtZTY AND STATE OFtpgANDON HOUSE SEWERFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE RIBED RESIDENTIAL-PROPER Y. BACKFILL SEPTIC TANKS ❑ol SEEP PIT(S) ❑ CESSPOOLSATURE PERMITTE - .
Or �ALMATIOl ROBERT A. WOOD
C M.0. GSR SUPERVISING-MECHANICAL ENGINEER