HomeMy Public PortalAbout10411 LOWER AZUSA RD_Sewer__ ,eA2o APPLICATION FOR PERMIT
cEeoe++-s� COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY'ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LANBIE, County Engineer ADDRESS 4/(
CASSATT D. GRIFFIN, Supt of Building F•
LOCALITY
NEAREST ...
FOR APPLICANT TO FILL IN caoss ST
FOR
FADDRESS
TION LOT NO. fid" OWNER
TRACT a&, �1� ADDRESSKs� ��
OT � �p NO.OF BLDGS.
NOW ON LOT L'� CITY l`. TEL.NO.
G -
GS DISTRICT NO. I GROUP MAP
TOR " BK PG
c it C g � c CONNECTION DATA
/ r J
TTE^L..NO./ ��° { S ONTATE
ATION NO. / '°'"• L•-'� ❑ S MANHOLE REFERENCE
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TO' a' -R P.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. GLV JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. tl .SCS
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
_ WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 1 a0�0^^) CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE sIli REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON•' -
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. _
SIGNED THIS AY19_ ' NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL -•- —-
OWNERS AGENT ob� ' BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S) - - - --
-AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1HAVE 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR' SEWAGE DISPOSAL SYSTEM - -
LICENSED AS REQUIRED BY LOS AN ,ELES COUNTY STA 'OF DISCONNECT PLUG AND
CALIFORNIA 0 1 TH :'GAL NETR - F/TH ROVE ABANDON HOUSE SEWER _
DESCRIBED R IDENT L RO E ,,1 BACKFILL SEPTIC TANKS ❑
SIGNATUREEP. PIT(S) CESSPOOLS
OF PERMiTTE `" - •
®" VALIDATION ROBERT A. WOO
cK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
ACo 4 0 9 9 5 AUG 2.1 10 A 4.5 0 :
D
S&E-668 11.55 APPLICATION FOR PERMIT
5&E•6 '
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, SUPT of BUILDING LOCALITY L`"' efv-1-7
FOR APPLICANT TO FILL IN ceoss sr. lf7�jy-GLp �✓t4-
LEGAL
DESCRIPTION LOT NO. OWNER J� qMAIL
BLOCK TRACT / �'^ ✓ ADDRESS
N0.OF BLDGS. L CITY. TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS r✓-� DISTRICT N0. GROUP MAP
BK PG
CONTRACTOR,-,- �1 �� �
///07 �J ' CONNECTI,O,N DAT,
ADDRESS
0 /CGI Cf�l� Sl t
/r ®B C S A ION d"!B DEPTH -JiP1•'CR
CITY J f6'/ L TEL. N0, f/� �f-
n El STATE MANHOLE REFERENCE
I OWER
REGISTRATION NO. /5(3��y O—Q( 2
No. DESCRIPTION OF WORK FEE
USE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM p
Y. CURB P.L. M.L. TO P.L.
—<B IC SEWER @ $3.50 V91 go
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EXTN.,CESS POOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. ��� JOB NO.
HOUSE SEWER CONNECTING TO 0-5 73 PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO _
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
G CONNECTION CHARGE FEE
OWNER'S PERMIT $
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 1c, DD
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY/ 19 CONNECT ADDITIONAL
OWNER OR ��. BUILDING OR WORK
OWNERS AGE N ate,_`, SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGEL ,ICOUNTY AND 3-E OF
CALIFORNIA OR THAT I AM T I LE L OWN ST ABANDON HOUSE SEWER OF T ABO
DESCRIBED RES,NJEIG PROP T,Y: BACKFILL SEPTIC TANKS C3
SIGNATURE .�,.
P.PITS) ❑ CESSPOOLS
OF PERMITTEE �/ S
JOHN A. LAMB I . OUNTY ENGINEER i•+�VALI M.
0. ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
/..CK. EE.O, CASH