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HomeMy Public PortalAbout9615 LIVE OAK AVE_Sewer__ D 6&E-689 11-55APPLICATION FOR PERMI`I, - .1 6 8 E-8 - ' DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY FOR APPLICANT TO L �/I CROSS ST. LEGAL OWNER r DESCRIPTION LOT NO Q _ MAIL BLOCK TRACT / ADDRESS ( N0. OF BLDGS CITY TEL. NO 3 SIZE OF LOT NOW ON LOT USE OF DISTRICT NO BUILDINGS GROUP MAP K PG CONTRACTOR & Cti - — ® ADDRESS CONNECTION DATA U STATION CZ DEPTH / CITY L ll/l�N T z. C TEL. N0. - MANHOLE REFERENCE _ UPPER �-STATE 5 LOW E REGISTRATION NO. l b ElCOUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM f ' PUBLIC SEWER @ $3 50 Q Y. CURB P L M L TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE PIT. DRAINFIELD C.CO. IMP. NOy JOB N O EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 HOUSE SEWER CONNECTING TO a� PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO s b CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT ' WORK TO HOUSE SEWER Q $1 00 PERMIT NO ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ o0 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE S o I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED con• APPROVALS DATE INSPECTOR'SSPGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. 7� NEW HOUSE SEWER _ SIGNED THIS DAYCONNECT ADDITIONAL fdF 19_L5_ / /J1 J-) OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PITS) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL❑ 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COU TY AND STATE OF ABANDON HOUSE SEWER c CALIFORNIA OR THAT I AM E LEGAL O N R OF THE ABOVE _ DESCRIBED RESIDENTIAL PROP TY BACKFILL SEPTIC TANKS❑ SIGNATURESEEP. PIT(s)'❑ CESSPOOLS❑ OF PERMITTEE _70z'14. JOHN A LAMBIE, Co u ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR CK. m0 CASH LACo 6 4 7 © V-1 NOV 10 10 - A 5.0 0 N Y7"ONIF03PEI / 6A642 0-63 'APPLICI MIT 76A 642D • COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Buildmg LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF :?RICT NO GROUP MAP PROCESSED BY BUILDINGS 1� PG CONTRACTOR ADDRESS CONNECTION DATA />,- STATION DEPTH CITY01 (O ❑ STATE MANHOLE REFERENCE REGISTRATION NO ❑ COUNTY aA LOWER NO DESCRI ,TION OF WORK FEE TYPE OF CONNECTION LENGTH FRO HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L } PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO d PITS AND/OR DRAINFIELD Q SIO 00 CO IMP NO JOB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V PRIVATE DISPOSAL SYSTEM @ $3 00 ix CONNECT ADDITIONAL AFFIDAVIT W"V" 1ASIMINT RER NO D CORD INSTATE O WORK TO HOUSE SEWER E3 00 I-- OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN CESSPOOL,DRYWELL MANHOLE @ 11 00 d ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT Z PERMIT NO INDUSTRIAL %• WASTE APPROVAL CHA GE OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS D 19_ OWNER OR NEW HOUSE SEWER OWNERS A N CONNECT ADDITIONAL ADDRESS BUILDING OR WORK D / v✓ I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND/OR DRAINFIELD AND STA E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY TH AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REOUIR BY LOS ANGLE OU TY AN STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH I AM THE,LEGAL NER'OF A INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A OVE SCRIBED SIDENTIA R ERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITT_EE BACKFILL SEPTIC TANKS El SEEP PIT(S) ❑ CESSPOOLS El ^VALIDATION ROBERT A. WOOD M O CASH SUPERVISING MECHANICAL ENGINEER �_ nr-2 24. 1 0 D 5.00N