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HomeMy Public PortalAbout9656 LIVE OAK AVE_Sewer__ 76A642D 65, APPLICATION FOR PIE!RMOff' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONBUILD+'NG JOAN A. LA�IBIE, County Engineer ADDR R. COLE AN 11'. JEN'KINS,Sup't. of Building P LOCALITY NEAREST :::7 FOR APPLICANT TO FILL IN `ROBS ST. LEGAL �� .- -7 �` / 01 DESCRIPTION LOT NO. //��1i..��'__/ /,,y/ OWNER BLOCK TRACT dolVl44eP � Ki(j'd AIL ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF 6 BUILDINGS DISTRICT N' . GROUP MAP PROCESSED BY -- BK I,PG _ CONTRACTOR ^ i� '4— /�{� "` ADDRESS CONNECTION DATA C STATION /J I /f I DEPTH CITY LIC S y LICENSE NO. e �(/ CLASS G y Z MANHOLE REFERENCE OWER NO. DESCRIPTION OF WORK FEE O ECTION LENGTH FROM y�/ HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. PUBLIC SEWER C $ 5.00 s UL' SEPTIC TANK. SEEPAGE PIT OR h P.C.NO. C PITS AND/OR DRAINFIELD C $10.00 CO.IMP. NO. � V JOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. A / V PRIVATE DISPOSAL SYSTEM C $ 3.00 CONNECT ADDITIONAL BLDG. OR AFFIDAVIT WAIVER 14SIlINT RECORD, INSTR.NO. DATE O WORK TO HOUSE SEWER C $ 3.00 A L rER_,`R-ET-ATR-OR ABANDON HOUSE �J SEWER OR DISPOSAL SYSTEM C $ 3.00 W A HWY.OR ST.WIDENING d to EXT N.,LESS POOL. MANI?OLE C $ 5.00 y STATE ENCROACH DIT /yI b I PERCOLATION TEST C $ 5.00 PERMIT NO. //j[,� INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 CHARGES AUTIiORIZATION TOTAL FEE ap CONNECTION CHARGE FEE A HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPEC R•5 SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGEN CONNECT ADDITIONAL BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT•llI AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED/� LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I M THE EGAL OWNER OF, � ID INTEND TO DISCONNECT PLUG AND IIA RESIDE IN, THE ABO DESCRI D RE I ENTL/- PERTY. CC ABANDON HOUSE SEWER SIGNATUREBACKFILL SEPTIC TANKS ❑ OF PERMITTEE - SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK. M.O. CASH :5 0 5 OZ sE 3 0 1 0 o 7.00 :65-65 76AA6420 APPLICATION ION FOR PERMIT64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING : .JOHN A.LANIBIE. County Engineer d ADDRESS COLEMAN W. JENKINS,Supt. of Building LOCALITY NEAREST 2 FOR APPLICANT TO FILL IN CROSS 5T. LEGAL -�iy- - � s DESCRIPTION LOT NO. ®I�/ �� V'�� �j-J�// OWNER MAIL BLOCK TRACT ��� ® /'✓ ADDRESS NO. OF BLDGS. 9 s �9 Q t SIZE OF LOT NOW ON LOT CITY TEL. NO., � V USE OF r BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY BK PG CONTRACTOR -5,0 ADDRESS CONNECTI(O�N DATA CITY N b y it STATION DEPTHe��EL. SS CS d, (/ I 6 MANHOLE REFERENCE LOWE NO. DESCRIPTION OF WORK FEE _ T OF TION LENGTH FROM I� HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. PUBLIC SEWER ^ $ 5.00 g SEPTIC TANK, SEEPAGE PIT OR //�� P.C.NO. d PITS AND/OR DRAINFIELD C $10.00 CO.IMP. NO. / /��/� JOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. ! V PRIVATE DISPOSAL SYSTEMC $ 3.00 99 CONNECT ADDITIONAL BLDG. OR 'AFFIDAVIT wAIVEN EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $ 3.00 O 'ALTER, R AI OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM C-' $ 3.00 �4•d/ T, DRAINFIELL) HWY.OR ST.WIDENING a EXTN„CESSPOOL. MANHOLE C $ 5.00 STATE ENCROACHM PERCOLATION TEST @ $ 5.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $1 21 00 CHARGES AUTHORIZATION TOTAL FEE ;7 d e CONNECTION CHARGE FEE 'IHAVE 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 INSPECTO 'S SIGNATURE SIGNED THIS DjY F 19_ OWNER OR NEW HOUSE SEWER OWNERS AGE. V'/ CONNECT ADDITIONAL - BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT-I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR _ LICENSED AS REQUIRED 8Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I/ �RIB HE LE AL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO ES - RESIDENTIA,LJ PR PERTY. .ABANDON HOUSE SEWER SIGNATURE ❑ OF PERMITTEE BACKFILL SEPTIC TANKS SEEP,PIT(S) [I CESSPOOL S ❑ VALIDATION CK. M.O. CASH LAE05 0 4 8- SEP 3 0 1 O D T0 0- 5,f5 76A642D APPLICATION FOR PERMIT 76A 64 '• ' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ` JOHN A. LAMBIF' County Engineer ADDRESS 47, COLF..61AN W. JFNKINS, Sup't, of Building LOCALITY NEAREST C FOR APPLICANT TO FILL IN CROSS 5T LEGAL DESCRIPTION LOT NO. OWNER AIL M BLOCK TRACT �[� fC Q^" ADDRESS �• NO. OF BLDGS. C+� SIZE OF LOT NOW ON LOT CITY e L. -NO. 6` /V USE OFF BUILDINGS DISTRICT NO. GROUP MAP .-/P�RpOyC�E�-SSED BY BK PG CONTRALTOW © ADDRESS CONNECTION DATA CITY ( TEL N /A STATION -? �� DEPTH LICENSE LICENSE !6' NO. CLASS a MANHOLE REFERENCE NO. G SCRIPT ON OF WORK FEE TY F 01 ION LENGTH FROM HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. PUBLIC SEWER @ $ 5.00 SEPTIC TANK, SEEPAGE PIT OR //' /� P.C.NO. CL PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. lv JOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM C $ 3.00 ! 9J CONNECT.ADDI ADDITIONAL BLDG. OR r����ORD. INSTR.NO. DATE O WORK TO HOUSE SEWER CC' $ 3.00 A T R, REPAIR OR ABANDON HOUSE - U SEWER OR DISPOSAL SYSTEM C` $ 3.00 -W OVERFN HWY.OR_ST.WIDENING (L EX T N.,CESSPOOL, MANHOLE @ $ 5.00 Ny STATE ENCROACHb '5 aj7 PERCOLATION T ST @ $ 5.00 PERMIT NO. u INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE J 'i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPEC 'S 51GNATUE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT F�LCONNECT ADDITIONAL // BUILDING OR WORK Y ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) / AND/OR DRAINFIELD 7 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY TH9T I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED/ LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM ' CALIFORNIA OR T � WNER OF. 'ND INTEND TO DISCONNECT-PLUG ANDRESIDE IN, THE ENTIALOPERTY. ABANDON HOUSE SEWERSIGNATUREL BACKFILL SEPTIC TANKSOF PERMITTEErL� E]SEEP,PIT 5) El CESSPOOLS ALIDATION CK. M.O. CASH - 1&5o V8 SEP 3011 D 25*. 0M 5-65 76A642D APPLICATION FOR PERMIT 76A 64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING:_AND SAFETY DIVISION BUILDING s JOHN A. LAMBIE. County Engineer ADDRESS COL.ENIAN W. JENKINS,SuP't. of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. yrs LEGAL DESCRIPTION LOT NO. 4loe OWNER BLOCK TRACT ��i� 0 MAIL ADDRESS NO. OF BLDGS. O SIZE OF LOT NOW ON LOT CITY EL. -N O.Age !4� USE OF BUILDINGS DISTRICT NO. 'GROUP 1 MAP PROCESSED BY r CONTRACTOR ADDRESS 000!!! CONNECTION DATA CITY EL. N !O STATION 7_ DEPTH LICENSE LICENSE NO. CLASS MANHOLE REFERENCE 1 (/'V'V OWER NO. nESCRlPTION OF WORK FEELENGTH FROM ^y HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. �vy'�� TY F N ION PUBLIC SEWER @ $ 5.00 SEPTIC TANK. SEEPAGE PIT OR P.C.NO. a PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. /// HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $ 3.00 v CONNECT ADDITIONAL BLDG. OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER 2 $ 3.00 O R. RE A OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM C $ 3.00 HWY..OR ST.WIDENING E%T N.,CESS POOL, MA NHCLE @ $ 5.00 N STATEENCRO PERCOLATION TEST @ $ S.OG PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT . $ o CHARGES AUTHORIZATION TOTAL FEE Q CONNECTION CHARGE FEE 'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN N. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR' NATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT ,. CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) j 1 IH ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING dI PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY TH I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRE Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM \� CALIFORNIA OR THAT M THE 'EGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE "I N, THE AB DESCR /E SIGNATURE ///(D...rrr///RESpD/JE�NTIAL%%/JJ�/R 7O P-E'RT/Y./ ABANDON HOUSE SEWER � �?:Ls[%7 /� '���A.0-!J BACKFILL SEPTIC TANKS ❑ OF PERMITTE .��4 ..��cc SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK. M.O. CASH Lkb,5-0 4 '9�8 SEP 30 1 1 D 2 5'.00-