HomeMy Public PortalAbout9654 LIVE OAK AVE_Sewer__ 5-65
76A645-65
APPLICATION FOR PERMIT.
76A 64
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING r
JOAN A. LA6IBIE, County Engineer ADDRESS t !�
CLE,NIAN W. JENKINS,Sup't. of Building LOCALITY . . r
NEARE
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL '.~ ,r-- ,e I e
DESCRIPTION LOT NO. ✓t i✓-„' •`� - OWNER
6� 1 �� �+ y�• MAIL r _ "1
BLOCK TRACT f .,d„' fir',¢:,' : 3 fo'�',f,'"5'+Y / a"'.k ADDRESS ��✓�, iiI« f �'°
NO. OF BLDGS. P
SIZE OF LOT NOW ON LOT CITY
USE OF �r
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED.BY
BK PG
✓^ l fit^
CONTRACTOR
ADDRESSt, ,'
CONNECTION DATA
CITY("' `,i t-> f TEL. NO: y STATION ,meq {ice, DEPTH
NOC SE { .. ./ CLA SSSEG, r - VPP.ER
_i MANHOLE REFERENCE LOWER_
NO. DESCRIPTION OF WORK FEE Ti��t"PE OF 60 N-ECTION LENGTH FROM '.
HOUSE SEWER CONNECTING TO �.. Y. ,,.� y.✓f.�GUiftH P.L. M.L.TO P.L. p:-;' , 0-
PUBLIC SEWER @ $ 5.00
SEPTIC TANK, SEEPAGE PIT OR ... ,,�• -^ P.C.NO. O
PITS AND/OR DRA INFIELD @ $10.00 Co.IMP. NO. /'?. " :� JOB NO. ,.-d V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
LU
PRIVATE DISPOSAL SYSTEM @ $ 3.00 _ L LL.
CONNECT ADDITIONAL BLDG, OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER @ $ 3.00 •. '•,
EPA OR ABANDON HOUSE -
SEWER OR DISPOSAL SYSTEM . @ $ 3.00 a
E117 ATN-F1 HWY.OR ST.WIDENING �7
EXTN.,CESSPOOL, MANHOLE @ $ 5.00 O
_ STATE ENCROACHMENTq
PERCOLATION TEST @ $ 5.00 PERMIT NO. -
\'
s - INDUSTRIAL _
WASTE APPROVAL F'
CHARGES
OWNERS PERMIT $ 2 Oo.
AUTHORIZATION I TOTAL FEE ? {e CONNECTION CHARGE FEE
.'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
'.TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
NTO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
'
Sip NED THIS ! D+4YF
•OWNER OR f '�
OWNERS AGENT2 1 -+''•'ft. u ” NEW HOUSE SEWER
CONNECT ADDITIONAL
ADDRESS
BUILDING OR WORK
'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP.PIT(S) -
. STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
ITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING
,PLUMBING AND SEWERS. CESSPOOL [IDRYW ELL [I
I HEREBY CERTIFY THAT I R
.AM PROPERLY REGISTERED AND/OR ALTER, REPAIR,SEWER OR
I{ICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
:CALIFORNIA OR THAT B �1•A/M THE.LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
ABANDON RESIDE IN, THE AJ+ O,S+ CRIBED RESIDENTIAL PROPERTY. - .
r�u1' a DISCHOUSE SEWER
SIGNATURE • "�('
OF PERMITTEE F - ri y. r - BACKFILL SEPTICTANKS El
SEEP.PIT(S) ❑ CESSPOOLS ❑
VALIDATIO/.N.-
_ • CK. M.Cl. j CASH) - -
t 0 4
-
7 5-65
6A642D APPLICATION
p LICAryION FOR PERMIT RMIy
-
COUNTY OF LOS ANGELES' SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILD NG
JOHN A. LAMBIE,"County Engineer ADDRESS
COLEMAN W. JENKINS,Sup't. of Building '
LOCALITY
NEAREST.
FOR APPLICANT TO FILL IN C ROSB BT: �C
LEGAL
DESCRIPTION -' LOT NOit w. OWNER"
r. M AIL +.,.: jor
BLOCK TRACT r�31'' „, :""� ' +��`..yr..¢,K .�' g ADDRESSA
NO, OF BLDGS. �.• s / �.
SIZE OF LOT NOW ON LOT •CITY :b EL. •NO.
USE OF
BUILDINGSDISTRICT NO.1 GROUP MAP PROCESSED BY
'yr p pp
BK PG
CO NTRA CTO .� r` �yy, ih... •s"� - ' e 4r.W` :kf ""�1 y >ir j
ADDRESS ,; ,}' „.w r ` ,p CONNECTION DATA `
r ` '� STATION DEPTH
.w, ya, ;ap "" �y C
•CITY ,,^ a' �.. TEL. NO 71 4•. P
..LIC NSE LICENSE yJ,�` MANHOLE REFERENCE '•N:,k3P.ER
ANO. CLA 55 •,,.x^ "T i�J' ,<LOWER`
)NO. IDESCRIPTIONFOF WORK FEE T EOF CONNECTION LENGTN FROM
HOUSE SEWER CONNECTING TO Y. °`yl.,�,, UR'9+:.. P.L. M.L.70�,.L. .^",-: d
I PUB LIC.SEWER @ $ 5.00 P.C.NO. \ O
j SEPTIC TANK, SEEPAGE PIT OR - CO. IMP. NO. !.')4'ti' ""' .108 NO. U
j PITS AN DOOR'DRAINFIELD @ $10.00
i LU
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. J
PRIVATE DISPOSAL SYSTEM C $ 3.00 f t✓
I CONNECT ADDITIONAL BLDG. OR AFFIDAVIT wAlvEx EASEMExT .RECORD. INSTR.NO. DATE
WORK TO HOUSE SEWER @ $ 3.00 s,
.t qTER, REPAIR OR ABANDON HOUSE -
SEWER OR DISPOSAL SYSTEM C $ 3.00 - e�
UVERF-E-0 UHAJ1tLU HWY.OR ST.WIDENING
OL, M •• O'
a7
jl EXTN.,CESS POANIN.O LE @ $ 5.00 '
STATE ENCROACHMENT
-PERCOLATION TEST�r1 @ $ 5.00 PERMIT NO iy?•�7. f +'1• r�{
/' INDUSTRIAL
`++Y t^N ,rY • f WASTE APPROVAL
OWNER'S PERMIT CHARGES
CONNECTION CHARGE FEE
I UTHORIZATION TOTAL FEE ,rw
I"HAVE AT THIS DATE A CONTRACT WITH THE HEREIN r"�'s REIMBURSEMENT FEE
G EEaC0 N;
TRACTOR UB CONNECT THE ABOVE DESCRIBED EXISTING DW FEEING APPROVALS
T�O�THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE '
Sl GNED THIS - DAY OF
OyNNER OR - - [NEW HOUSE SEWER
OWNERS AGENT
ONNECT ADDITIONALUILDING OR WORK
AgDRESS
`II HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,D
PIT(S)
A\ AND�OR DRAINFIEL
AfSD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PL^V MBING AND SEWERS. - ' CESSPOOL ❑ DRYW ELL ❑
IN HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND�OR y ALTE R,REPAIR,SEWER OR
LIO�.NS ED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA,,1 AM THEILEGAL-OWNER OF.t,.ANDINTEND TODISCONNECT PLUG AND
RESIDE IN, THE A DESC "BED RE ID ENT IAL ePROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTE - f� ,�,; BACKFILL SEPTIC TANKS ❑ -
SEEP,PIT(S) ❑ CESSPOOLS j
- •-VALIDATION �'
CK... � M.O. CASH -
a