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Home My Public Portal About10203 LOWER AZUSA RD_Sewer__ :6 5-65 76AA6420 APPLICATION FOR PERM 64 , Q COUNTY OF LOS ANGELES S E��R-S G E DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOAN A. LAUBIE, County Engineer ADDRESS COLENIAN W. JENKINS,Sup't. of Building /]S/ve LO CALiTY 7 NEAREST FOR APPLICANT TO FILL IN CROSS ST. T'Z LEGAL DESCRIPTION LOT NO. ,� OWNER '&'g, 7vr {N� MAIL BLOCK TRACT `G ADDRESS —fAl4"/e ( NO. OF BLDGS � SIZE OF LOT �_J� NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROU MAP PROLE ED BY BUILDINGS P. CONTRACTOR CONNECTION DATA ADDRESS 4/ ` _ ,,:� CITY ` TEL. NO. STATION DEPTH LICENSE LICENSE .b�- NO. •�y CLASS �� MANHOLE REFERENCE LOWER 14 -Ito [• NO. 1 DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGT ROM OUSE SEWER CONNECTING TO Y. CURB P. M.L.T P.L. PUBLIC SEWER C $ 5.00 S PT C TANK, SEEPAGE PIT OR CO.IMP.NO. JOB NO. 0. PITS AND/OR DRAINFIELD C $10.00 O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U PRIVATE DISPOSAL SYSTEM C $ 3.00 CONNECT ADDITIONAL BLDG. OR .• G('l�v'Y AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE 0 WORK TO HOUSE SEWER C $ 3.00 C 77 CC/0 REPIR OR ABANDON HOUSE SEWER OR DISPOSAL SYS TF.M C $ 3.00 HWY.OR ST.WIDENING EXTN.,CESSPOOL, MANHOLE P $ 5.00 V) STATE ENCROACHMENT PERCOLATION TEST C $ 5.06 PERMIT NO. /l INDUSTRIAL 1 WASTE APPROVAL OWNERS PERMIT $ 2 00 CHARGES AUTHORIZATION TOTAL FEE Loi CONNECTION CHAR E FEE 'IHAVE 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 INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ 01) OWNER OR NEW HOUSE SEWER p' OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD 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 THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DI SPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AN INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOV SCRIBED RESIDENTIAL PR ERTY. ABANDON HOUSE SEWER SIGNATURE /' BACKFILL SEPTIC TANKS ❑ OF PERMITTE (rte ❑ SEEP.PIT [IS) CESSPOOLS VALIDATI CK. M.O. CASH Li i1�0 127 8 OCT-] 4? 1 �' p 5.0 J� r 7696 - APPLICATION FOR• PERM T _ 76A6420 42D COUNTY OF LOS ANGELES SEWER-SEWAGE ISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING V JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEARE C ROSS ST. FOR APPLIC TOS FILL LEGAL DESCRIPTIO LOT NO. +� OWNER p MAIL /^ BLOCK TRACT ADDRESS C- O. OF EfLDG S. SIZE OF LOT NOW ON LOT CITY/ 1P l EL, NO. USE OF /'` PG DISTRICT NO BK GROUP MAP PROCESSED BY BUILDINGS (...'"Ep� -/,/f (/n%, CONTRACTOR( a �(` nC Y `J r•. " _ -C > ADDRESS 'o - ( _ y CONNECTION DATA STATION DEPTH _ CITY TEL.,NO.1 ' 60 ❑ STATE MANHOLE REFERENCE REGISTRATION NO. ❑ COUNTY � p &I LOW ER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH F M HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P. . ' PUBLIC SEWER @ $5.00 P.C.NO. SEPTIC TANK,SEEPAGE PITOR JOB NO. PITS AND/OR DRAINFIELD • @ S10.00 CO.IMP.NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM @ 83.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE � WORK TO HOUSE SEWER @ S3.00 0 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL.MANHOLE 85.00 ALTER,REPAIR OR AB N USE HWY.OR ST.WIDENING OR DISPOSA SYSTEM - 53.00 \ ev STATE ENCROACHMENT N o PERMIT NO. 1 ( INDUSTRIAL dry WASTE APPROVAL CY CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE 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 TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS 'DAY OF 19_ OWNER OR - NEW HOUSE SEWER . OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK _ ADDRESS SEPTIC TANK,SEEP.PIT(S) ., 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS.APPLICATION AND/OR DRAINFIELD ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM PLY WITH ALL COUNTY ORDINANCES AND STATE LAWS. REGULATING PLUMBING AND SEW - CESSPOOL ❑ DRYWELL ❑ - I HEREBY CERT Y THA P PERLY GI RED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS R OU IRE Y LES O AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT A E LEG OW F F AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE CRIB D ESID TI PROPERTY. ABANDON HOUSE SEWER SIG AT RMITTE - BACKFILL SEPTIC TANKS El t^' EEP,PITS) ❑ CESSPOOLS ❑ - ALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH 9. 5 7 5'� U1 3 1 D 5.0 0'" 78A842D _ .Io'O.tl. =B �_''Yd B"'i I®B'a FOR ul E �C W I CE808.8 58 --- COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND`.SAFETY DIVISION ADING °ADDRESS," ., DRES JOHNIN'A. LAMBIE,.County Engineer CASSATT D. GRIFF , Sup't'of'Builcing.;' LOCALITY , :. NEAREST77 FOR.APPLICANT-TO'FILL IN':_ :'" < caoss.sT:. . .LEGAL DESCRIPTION LOT N0. OWNER .�" '" . BLOCK 'TRACT 1 MAIL „ i � .. ., .° ADDRESS. - "SIZE OF LOT NOW ON LOT ' CITY TEL.N0: USE OF �. 'BUILDINGS' / .. DISTRICT_,NO;j GROUP MAP PROCESSEDBY ". BK PGIle d CONTRACTOR 'f4!�C� ADDRESS ,� q CAV 7--i''1,:Ci • " CONNECTIO .DATA .. e t CITYTEL;NO. 3 3 ^STATION DEPTH • SATE; /' 0. �_ MANHOLE EFERENCE id REGISTRATION NO. COUNTY LOWER" No DESCRIPTION'-O WORK FEE' ; HOUSE SEWER CONNECTING TO PUBLIC SEWER Q $5.00 v - TYPE'OF TION LENGTH FROM SEPTIC.TANK,SEEPAGE PITOR. Y. URB :PSL. M.L:-TO P:L. PITS,AND/OR DRAINFIELD @_$9.00 OVERFLOW SEEPAGE PIT,DRAINFIELD' EXTN.,CESSPOOL;DRYWELL,MANHOLE HOUSE.:SEWER`CONNECTING TO P C:INO. ',PRIVATE DISPOSAL SYSTEM .0.11.00 CO.14P.,N6. JOB NO,. CONNECT ADDITIONAL BLDG`OR. TRUNK PERMIT NO.,. ROAD PERMIT NO: 'WORK TO-HOUSE SEWER @ $1`.00 'ALTER;'REPA'1ROR ABANDON HOUSE : STATE"ENCROACHMENT - 'SEWER OR DISPOSAL SYSTEM . Q."$1.00 'PERMIT�N0. INDUSTRIAL , W ASTE'APPROVAL CHARGES OWNERSI'PERMIT '_`2 00, CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT„FEE I HAVE'AT THIS DATE A'CONTRACT WITH'THE RERETN NAMED'CON. APPROVALS DATE .t INSPECTOR'S SIGNATURE 'TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE.PUBLIC SEWER SIGNED THIS < 5 SAY OF IgQ NEW HOUSE SEWER •• CONNECT,ADDITIONAC - OWNER OR BUILDING OR'WORK OWNERS AGENT �°" "SEPTIC-TANK;SEEP,,PIT(S) ADDRES ND/OR DRAINFIELD IHEREBY ACKNOWLEDGE THAT,I HAVE. READ THIS APPLICATION AND STATE THATm THE ABOVE IS•CORRECT.AND AGREE TO.COMPLY CESSPOOLI❑. DRYWELL•❑, WITH ALL COUNTY ALTER,REPAIR,'SEWEOR PLUMB NG•AND SEWERS. -SEWAGE ,AND STATE LAWS REGULATING" R SEWAGE DISPOSAL`-SYSTEM I HEREBY CERTIFY,THAT I AMS PROPERLY'REGISTERED AND/OR' DISCONNECT'PLUGAND LICENSED-AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR, T T •1 AM, THE,_LEGAL OWNER OF. THE ABOVE —ABANDON'HOUSESEWER �• DESCRIBED 'RESIDE IAL PROPERTY •. BACKFILL SEPTIC TANKS❑_' L'• �G-�� SIGNATURE SEEP PIT(S) ❑ CESSPOOLS OF'PERMITT �*` 7 G ®a VA. ATIO SUPERV18IIyG MSGIiANICAL' ROBERTA WOOD.' C6 m:O 6A8H ENGINEER