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Home My Public Portal About10419 LOWER AZUSA RD_Sewer__ i 24610�RT1 CE8088.60 APPLICATION ION FOR °' PERMI 78A842D COUNTY OF LOS ANGELES SEWER—SEWAGE ®OSPOS� DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7ADDRE �f JOHN A. LAMBIE, Countp Engineer �-y.� WILLIAM A. JENSEN, Supt of Building FOR APPLICANT TO FILL IN LEGAL �'� OWNER DESCRIPTION LOT NO t '. BLOCK TRACT /f MAIL �306"T � ADDRESS NO.OF BLDGS. , SIZE OF LOT NOW ON LOT S CITY TEL. N0. USE DI /��5',' '..�C� w. `. BUILDINGS DISTRICT N0. GROUP MAP `I{ PROC CONTRACTOR �. I T�K/7 ADDRESS� �— �✓ CONNECTION DATA CITY STATION DEPTH _ �oi1r� STATE MANHOLE REFERENCE .UPPER REGISTRATION NO. COUNTY LOWER . NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNE ON LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 - P.C.N0./ HOUSE SEWER CONNECTING TO " CO. IMP. JOB N0. PRIVATE DISPOSAL SYSTEM @ $1.00 - p. CONNECT ADDITIONAL BLDG.ORP. TRUN ERMIT N0. ROAD PERMIT N0. U WORK TO HOUSE SEWER @ $1.00 ALTER,REPAIR DA3POR OSAL ABANDON HOUSE @ $1 00 ST ENCROACHMENT94 P MIT N0. O F INDUSTRIAL tJ WASTE APPROVAL W CHARGES - L� OWNER'S PERMIT Sj CONNECTION CHARGE FEE 3' AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE - TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL +" OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR _ PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY EGISTER AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES , AND S ATE OF' ABA ON HOUSE SEWER CALIFORNIA OR THAT M THE LEG OF THE ABOVE BA FI LL SEPTIC TANKS ❑ DESCRIBED RESIDENT L P OPERTY. P.pIT(S) ❑ CESSPOOLS ❑ SIGNATURE OF PERMITTEE ®R ALIDATION ROBERT A. WOOD CASH SUPERVISING MECHANICAL ENGINEER I�Gt6/�LlliU� 254 ` ,"o, Am 381 ® 189.00e 24650 ;Ns Ts CE8088.80 76A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES E` SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE. County Engineer � WILLIAM A. JENSEN. Sup't of Building LOCALITY .. NEAREST FOR APPLICANT TO FILL IN ceoss sr. LEGAL ` DESCRIPTION LOT N0. �V �r ,OWNER l� Lfe BLOCK TRACT MAIL OR A ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT I CITY - TEL. NO. oe USE BUILDINGS BK PG DISTRICT NO. GROUP MAP PROCESSED BY CONTRACTOR e �- –1-) C ,1 ADDRESS CONNE TION DATA �`•� CITY �� TEL.N0. S TION DEPTH g �A I� STATE MANHOLE REFERENCE ` REGISTRATION NO. < :!3e*-' H COUNTY - LOWER No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER _ TYPE OF CON EC LENGTH FROM PETS AND/OR DRAEINFPTIC TANK. GELDPIT OR @ $ 00 Y. C P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT, DRAINFIELD _ EXTN..CESSPOOL. DRYWELL @ S .00 HOUSE SEWER CONNECTING TO P-.C"N — PRIVATE DISPOSAL SYSTEM @ St 00 CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N ,I/ ROAD PERMIT NO. V WORK TO HOUSE SEWER @ $ .00 JY/ it ALTER.REPAIR OR ABANDONHOUSE - STATE ENCROACHMENT ca SEWER OR DISPOSAL SYSTEM C. 100 PERMIT NO. /� O I IJJ.ST4� + W i! CHARGES OWNER'S PERMIT 2 00 CONNECTION CHAk&FEE P AUTHORIZATION I TOTAL FEE 7Q7 Q a REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT T E.ABOVE DESCRIBED EXISTING DWELLING APPROVALS DQTE, INSPECTOR;SSIG ATU E TO THE PUBLIC SEW01 E SIGNED THIS At 19 NEW HOUSE SEWER OWNER OR 114 y CONNECT ADDITIONAL OWNERS AGEN BUILDING OR WORK �n ADDRESS SEPTIC TANK,SEEP.PITS) AND/OR DRAINFIELD 1 HEREBY ACKNOWICEDGE THAT I HAVE 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 pLTER,REPAIR,SEWER OR . SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY T T 1 M PROPER RED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRE BY L ANGELES CO Y A STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT ,AM HE LEGA R OF THE ABOVE DESCRIBED RESIDENT PROP RTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑ OF PERMITTE OFLIDATION ROBERT A. WOOD CK. M.o, CASH SUPERVISING MECHANICAL ENGINEER 2. 5 5 5w AUG 6 10 D 7,00^' 76A642DI'slISI0�1 APPLICATID �� 9&-E 663 3=5". OF .BUILDING AND SAFETY SEW E R=a SWAGE DISPOSAL" l- Department of County Engineer ' County of Los'Angeles BUILDING " .• nges . . , _WM J. FOX, COUNTY ENGINEER, ADDRESS. CASSATT'D.GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT 'TO::FML IST, . .;LEGAL -.. ��•„��-` - - _ _ _ "DESCRIPTION LOT NO. ,� .� OWNERall 0-41Al ' _ P : BLOCK � {,TRACT /. '51�'. 'ADDRESS /} NO: OF BLDGS, SIZE OF.COT/�(!l�J�J NOW ON LOT; •/:' - CITY. ripJ .le TEL.N0:" USE OF BUILDINGS ®� + �` - DISTRICT NO:, GROUP NIAP BK PG CONTRACTOR ADDRESS _ : CONNECTION DATA CITY EL: STATION DEPTH - - ❑ STATE MANHOLE.REFERENCE UPPER 'REGISTRATION_NO. - -❑ COUNTY - / LOWER. NO. DESCRIPTION OF WORK FEe M .HO USE SEWER CONNECTING TO - TYPE O C- NECTION LENGTH FROM - - ,Y.. 'CURB' P.L. ML. TO P.L. PUBLIC SEWER-` "@ $ 3150 - - -HOUSE SEWER CONNECTING TO - - - PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR --- P. C, NO. WORK TO HOUSE SEWER }:00 C07.1MP..NO.: JOB NO. ALTER OR,REPAIR EXISTING - SEWER OR DISPOSAL SYSTEM ,. 1.00 TRUNK PERMIT NO. - ROAD PERMIT NO. DISCONNECT:AND ABANDON SEWER STATE ENCROACHMENT - .ANO/OR•DISPOSAL SYSTEM 1.00 PERMIT NO: SEPTIC TANK, SEEPAGE PIT OR 'INDUSTRIAL...., PITS AND/OR DRAINFIELD 300 NDUSWASTERIAL OVAL. CESSPOOL-DRYWELL' SPECIAL CONDITIONS ONLY ,.2.00. .. CHARGES - - - CONNECTIONCHARGE FEE. . - - OW1\ER:S: PERMIT 1. . 00 . . AU.THORIZATIOId TOTAL FEE I0--tl REIMBURSEMENT FEE • l HAVE THIS DATE CONTRACTED ,WITH THE HEREIN NAMED CON." a TRACTOR TO- CONNECT THE ABOVE DESCRIBED EXISTING DWELLING : - APPROVALS "DATE:' INSPECTOWS.SIGNATURE TO THE PUBLIC SEWER - - ^.• N„. - _. -• • SIGNED THIS _DAY OF - 19 NEW HOUSE SEWER /Z � ,-�d�✓+-Ga%y"+^'�—� � ` OWNER OR - - _ CONNECT ADDITIONAL J pry OWNERS'- AGENT BUILDING OR WORK- - `✓-Cd f ,i,,.'R�t.Yfe: SEPTIC TANK,.SEEP;PIT(S) f ADDRESS - ,,.AND/OR DRAINFIELD - .,1 HEREBY ACKNOWLEDGE THAT1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO. COMPLY CESSPOOL❑ DRYW EL'L❑WITH ALL COUNTY ORDINANCES AND STATE' LAWS REGULATING ALTERREPAIR, SEWEROR PLUMBING AND SEERS.' -ALTER,.'' - ,. - SEWAGE DISPOSAL SEWER,OR. AL SYSTEM, _ 1� HEREBY.CERTIFY ,THAT I AM PROPERLY :REGISTERED AND/OR: - • - - _ LICENSED AS REQUIRED BY LOS ANGELESCOUNTYAND STATE-.OF *_DISCONNECT..PLUG-AND CALIFORNIA:' OR.THAT -1 AM- THE 'L - OWNER*OF THE ABOVE ."'ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS Fj - ' • -'SEEP. PIT(S) ❑. .CESSPOOLS 0 SIGNATURE OF PERMITTEE. 7 ... _ .. ,, �TALIDATIOPI , . WILLIAM`J.FOX: COUyyNT_ ENGINEER _ R.A.WOOD-CHIEF PIs6G. INSPECTOR' 4 ,Q:t . • d�: