HomeMy Public PortalAbout9552 LIVE OAK AVE_Sewer__ Aa42D
CEAPPLICATION FOR PERMIT
ceeoe a-sa COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION BUILDING
ADDRESSLl
rrOHN A. I.AMSIE, Count F Engineer //
CASSATY D. GRIFFIN, Supt of'Building LOCALITY' 2 /e / t
FOR APPLI T TO FILL IN NEAREST
CROSS ST.
LEAL
AN
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL -2
ADDRESS
0 OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE
BUILDINGS Iklej DISTRICT N0. q
GROUP MAP PR ED
BK PG
�ESS
CONTRACTOR r ei���/ d+✓f 9 j 1-4 l z �,!
ADDRESS /1 f' p�,� NNECTION ATA` �5
CITY TEL.NOd. �'� Z T TIO DEPTH -
D +v� COUNTY MANHOLE R ERENCE
REGISTRATION NO. LOWE
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO no
PUBLIC SEWER @ $3.00 ,._
TYPE OF CONNECTION LE GTH 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 TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. NO 2 JOB NO.
WORCONNECT K TO HOUSE IS WERONAL BLDG.OR @ $1 00 TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO
&-a INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PER I[T $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 0-0 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- -" - "
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INS ECTOR'S SIGNATURE
TO THE PUBLIC SEWER. n ,
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER D r *, outava
OWNER OR _ � l CONNECT ADDITIONAL
OWNERS AGENT �`� BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
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 [I
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 COUNT AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT t AM THE LEGAL OWN OF THE ABOVE
DESCRIBED RESIDENTIAL P RT .:w t BACKFILL SEPTIC TANKS E]SIGNATURE
EP PIT(S) 13CES OLS ❑
OF PERMITTE 4
®" VALIDATION ROBERT A. WOOD
C M.o, CASH SUPERVISING MECHANICAL ENGINEER
'2 5..0'0 :9
a
cAPPLICATION- FOR PERMIT
ssos aoe 8.sa COUNTY OF LOS ANGELESJ.
SE!lVEO:i-SE1iVAGE -DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer
ADDRESS
MMM
CASSATT D. GRIFFIN, Supt of Building LOCALITY l� ;
FOR APPLICANT TO FILL IN CRONEAREST
SS ST. I ( !f
LEGAL OWNER +
DESCRIPTION LOT N0. -
q
BLOCK TRACT MAILADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITYA(4.)# /4'O TEL NO
USE OF �f 3 DISTRICT NO. GROUP MAP PR ESSED B
BUILDINGS c
BK PG
CONTRACTOR
ADDRESS/ �j1,1,4RNNECTION DATA
CITY �j �' TEL NO. �_��ly S ATIO DEPTH O
REGISTRATION N0. / / COUNTY MANHOLE REFE E C ` R
No I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM I
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO - P C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 60•IMP. N0. JOB NO. '
CONNECT ADDITIONAL BLDG.OR y
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL -
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGDATE A CONTRACT WITH THE HEREINAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT �� BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
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
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNE F THE ABOVE
DESCRIBED RESIDENTIA PR TY. BACKFILL SEPTIC TANKS ❑
SIGNATUREit
* S P.PIT(S1 ❑ CES 00 ❑
OF PERMIT
OF ATION ROBERT A. WOOD
K.- M.0. CASH SUPERVISING MECHANICAL ENGINEER.
5.7-6`7,�3 JM 22)8 1 0 A 5.00