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HomeMy Public PortalAbout6420 LOMA AVE_Sewer__ 'B&E•883 12 54 APPLICAT"10' N "FOR PERMIT DIVISION OF WELDING AND SAFETY ! SEWER-SEVV�1 E I ISP�SI4L Depoxtmea! of County Engineer County of Los Angeles BUILDING �y WM.J. FOX, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SuwT of BUILDING- LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST LEGAL DESCRIPTION LOT N0, OWNER 6�L�'' '�(✓-�,I BLOCK TRACT /�T MAIL t - ADDRESS NO OF BLDGS. ' SIZE OF LOT ° NOW ON LOT I _ TEL USE OF BUILDINGS -�/..� a V'�"'-'_ DISTrCT NO. GROUP MAP, CONTRACTOR 'd % ADDRESS• .1 CONNECTION DATA CI TEL. 1� / STATION 7 VI j y �j DEPTH �. f REGISTRATION-NO. .S'�f rj / ❑ COUNTY MANHOLE UPPERREFERENCE L?"'" j SLOWER .,.►'a� / _ TYPE OF CONNECTIO LENGTH FROM NO. DESCRIPTION OF WORK FEE Y. CURB `L M L TO P L. HOUSE SEWER CONNECTING TO -PUBLIC SEWER Q $ 3 50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 / O/ CONNECT ADDITIONAL BLDG OR ` WORK TO ROUSE SEWER - 1 00 CO. IMP-NO. JOB NO ALTER OR REPAIR EXISTING ` SEWER OR DISPOSAL SYSTEM' 1 00 TRUNK PERMIT NO. ROAD 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- DRYW ELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 17, CHARGE CONNECTION CHARGE FEE OWNERS PERMIT $ 00 Z AUTHORIZATION I TOTAL. FEE — REIMBURSEMENT FEE IHAVETRACTORT TTOS CON ECTO THEA ABOVE-DATE-CNTRCTEDWDESCRBED EXISTINGA DWELLING APPROVALS DATE VINSPECITH THE HEREIN NMED CN- I SSIGNATURE TO THE PUBLIC SEWER - _ - _ SIGNED THIS DAY OF 19 HOUSE SEWER A07, Ta- e L5- P OWNER R• CONNECT ADDITIONAL' OWNERS AGE T BUILDING OR WORK ADDRES i'�"7 pi IaAlk� SEPTIC TANK, SEEP, PIT(S) , _AND/OR DRAINFIELD' I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION_ CESSPOOL[:1DRYWELL[3AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR N PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM ' I HEREBY CERTIFY THAT I 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 T E ABOVE , DESCRIBED RES IDENT IA P ERTY. BACKFILL SEPTIC TANKS❑ _ EP. PIT(S) ❑ CESSPOOLS❑ 11 ' SIGNATURE , OF PERMITTE WILLIAM J. FOX,COUNTY ENGINEER VALIDATION BY r�Cc� BY`� 9 V� SEP f3 4 4.5 0 DEPUTY DEPUTY' BY ® _ DEPUTY DEPUTY f CEB083-62 76A642D 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 G!/� WILLIAM A. JENSEN, Sup't of building LOCALITY NEARESTff FOR APPLICANT TO FILL IN CRDBS ST LEGAL ] / y DESCRIPTION LOT NO S.7 6P OWNER MAIL BLOCK TRACT 1171 S ADDRESS NO OF BLD GS SIZE OF LOT NOW ON LOT CITY /��, IlSor0l TEL NO USE OF _ .� r BUILDINGS l C ` ' l : i 4 1v BK PG I DIS/TRICT�J"7707O GROUP /��// MAP9 PROCESSED BY CONTRACTOR V G`,D [ L/ �ifjl J'VI J i "' i • _ 9 — ADDRESS ADDRESS I ��, � r �G , ' CONNECTION DATA CITYSChc-ria 6;;q60 /TEL NO / - '7'�(/5! STATION _.G a/,5 DEPTHSTATE �. REGISTRATION NO /'q ,/ COUNTY MANHOLE REFERENCE 3cp NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L O PUBLIC SEWER Q $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO /' PITS AND OR DRAINFIELD @ SIO 00 CO IMP N /��(j JOB NO V HOUSE SEWER CONNECTING TO TRUNK T O ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIYEa EASEME T RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD y EXTN CESSPOOL DRYWELL,MANHOLE @ $500 HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE _ SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s 2 00 [RES THORIZATION TOTAL FEE ©v CONNECTION CHARGE FEE AVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE CTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING THE PUBLIC SE.W.yy�E��R APPROVALS DATE INSPECTOR'S SIGNATURE GNED THIS�2.et_—DAY OF �cl 1C/ —1 9 NER OR NEW HOUSE SEWER NERS AG T_]7q CONNECT ADDITIONAL 77 /� DRESS /.7 t:•h'fZL`� BUILDING OR WORK 7-t74$- SEPTIC TANK SEEP,PIT(S) t HEREBY ACKNOWLEDGE THAT I HAV READ THIS PLICATION AND/OR DRAINFIELD V D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING MBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR ENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM IFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND IDE IN, THE ABOVE DESCRIBED R IDENTI L PROPERTY ABANDON HOUSE SEWER NATURE BACKFILL SEPTIC TANKS ❑ F PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH .1 7 8 5 JUL 2 4 1 0 D 5.00- B 76A642D CE 808(REV 6/781 ® ® ®�{� os APPLICATION IF'O6®e tl Es` MOT SEWER - SEWA►CE DISPOSAL. COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN DISTRICT NO GROUP MAP P CESS BY � � �PG , BUILDING � q a . ADDRESS D ion CONNECTION DATA, LOCALITY , NEAREST STATION DEPTH ` CROSS ST - - - UPPER ' MANHOLE REFERENCE _ LOWER OWNER - TYPE OF CONNECTION �' 'LENGTH FROM S - MAIL Y CURB P L M L TO P L 1 ADDRESS CO IMP NO JOB NO CITY TEL NO , LEGAL TRUNK PERMIT NO ROAD PERMIT NO DESCRIPTION LOT NO /• 8 + 9 a y s' AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE BLOCK TRACT ' I NO OF BLDGS SIZE OF LOT NOW ON LOT HWY OR ST WIDENING USE OF BUILDINGS STATE ENCROACHMENT PERMIT NO CONTRACTOR -r 1 .J U L ���- VL d INDUSTRIAL - / WASTE APPROVAL ADDRESS I Z- 1 (� �j .V G- ��+C"� •�. CHARGES CITY C Al (� ` / P Gy TEL NO z O 7 / ..7 7 CONNECTION CHARGE FEE + ' STATE LIC REIMBURSEMENT•FEE LICENSE NO ,7 (� Z CLASS u) I + NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR S SIGNATURE HOUSE SEWER CONNECTING TO PUBLIC SEWER NEW HOUSE SEWER SEPTIC TANK,SEEPAGE PIT OR , _ PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM SEPTIC CONNECT ADDITIONAL BLDG OR ANID/O DRAIN EEL,PIT(S) WORK TO HOUSE SEWER AND/OR DRAINFIELD OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ElDRYWELL❑ EXTN,CESSPOOL.DRYWELL,MANHOLE ALTER. _ HOUSE ee � ALTER.REPAIR SEWER OR Is� SEW O �V SEWAGE DISPOSAL SYSTEM 1 • 71 • DISCONNECT PLUG AND J- ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS❑ •• - - - SEEP PIT(S)❑ CESSPOOLS❑ OWNER'S 'Permit $ - yALIDATION :Q`- AUTHORIZATION' -TOTAL FEE "' ` " I n I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED.CON- •V. '•• OR M 7 A TRACTOR To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING yf�r✓7 rr//"�� TO THE PUBLIC SEWER ' •�T #-O wo 0 1,0_ S16NEDTHIS -I"- DAY OF - 19_ �` (�J�•"-" -_r rj /� OWNER OR 2 0 0 '�•4,O O OWNERS AGENT -_ .. ._ _ ... .. ,. 4� +.. ADDRESS _ D 0 0 1 41005 IHEREBY ACKNOWLEDGE THAT-I-HAVE READ THIS APPLICATION y •p AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY r. Q 5- ! 8 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ' PLUMBING AND SEWERS I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RE- SIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY lfOPER,TPROPERTYSIGNATURE -// '�--�-�TI OF PERMTE .L .;S '' I , D S&E-663 f 2.54 APPL.I�'iA'T"ION FOR PERMIT' 1 5 @ E-6 DIVISION 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 OF BUILDING LOCALITY -7-' NEAREST FOR APPLICANT TO FILL IN CROSS T �t}i/�j?t1 7 1 LEGAL S� ,\n AA_) � j a,) DESCRIPTION LOT N0. �. OWNER BLOCK TRACT MAIL ADDRESS NO OF BLDGS. ^'72� SIZE OF LOT NOW ON LOT G/' CITYall TEL. NO USE OF BUILDINGS L 21 �'' � �!t,.�+d — � DISTRICT NO. GROUP MAP CONTRACTOR - / A/K PG 5 ADDRESS - ey �� CONNE/CATION DATA G�U eC CITY TEL STATION `�' DEPTH REFERENCE MANHO REGISTRATION NO. ❑ COUNTY l�Q �/ LE LOWER TYPE OF CONNECTIOt � LENGTH FROM No DESCRIPTION OF WORK FEE Y CURB /P LJ M L TO P.L.. HOUSE SEWER CONNECTING TO 04 A/ 0w eQ4 r40 AI PUBLIC SEWER Q $ 3 50 _ a"� 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 _ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOS4L 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 CONNECTION CHARGE FEE OWNER'S PERMIT S 1 00 AUTHORIZATION _ TOTAL FEE �� REIMBURSEMENT FEE Cb/V/� 0-N 114,erf641. Iv �. TRACTORHAVE T TOS CONNECTDATE ONTRTHEA ABOVEWDESCRIBEDEXISTINGITH THE HEREIN A DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWERv� l yyB SIGNED THIS DAY OF 19LL NEW HOUSE SEWER , 1 .J�- OWNER OR CONNECT ADDITIONAL OWNERS AGENT Z41 „/ -BUILDING OR WORK ADDRESS SEPTIC TANK, SEEP, PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM IHEREBY CEPTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPER1Y. 1 BACKFILL SEPTIC TANKS❑ SEEP.PITS) ❑ CESSPOOLS kI SIGNATURE OF PERMITTEE - / WILLIAM J. FOX, COUNTY ENGINEER VALIDATION :BY BY _ - DEPUTY DEPUTY BY BY 4 ® DEPUTY DEPUTY