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Home My Public Portal About10667-10669-10671 LOWER AZUSA RD_Sewer__ 76A642D APPLICATION. FOR PERMIT COUNTY,OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF. COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADOREss > ;,NO. . WILLIAM A. JENSEN, Sup't of Building LOCALITYNEARSSTFOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION 'LOTN O. OWNERMAIL BLOCK. TRACT ADDRESSNO. OF LDGS. �-SIZE OF LOT NOW ON LOT CITYC R TEL.USE OF BUILDINGS DISTRICT NO. GROUP MAD BY CONTRACTOR / ADDRESS CONNEC - CITY /Qy TEL. NO. STATION DEPTH ❑ STATE/ UPPER MANHOLE REFERENCE REGISTRATION NO. !!! ❑ COUNTY, � LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION - LENGTH FROM HOUSE SEWER CONNECTING TO Y.' CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00' SEPTIC TANK,SEEPAGE PIT OR P.C.NO, }, PITS AND/ORDRAINFIELD @ $10.00 CO.IMP. NO. JOB NO, L1. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. -�(,� PRIVATE DISPOSAL SYSTEM @ $3.00. CONNECT ADDITIONAL BLDG.OR - AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO: DATE O WORK TO HOUSE SEWER @ $3.00 ' OVERFLOW SEEPAGE PIT,DRAINFIELD Y.1 EXTN..CESSPOOL,DRYWELL.MANHOLE @ -$5.00 HWY,OR ST.WIDENING YYYYJJJJ AG9�R7`R1•PM' 'R ABANDON HOUSE C. SEWER EM Q $3.00 Z ^'- 00 STATE ENCROACHMENT Z.PERMIT NO. - 4. .� INDUSTRIAL - ' .WASTE APPROVAL OWNERS PERMIT $j z 06CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE _ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC :SEWER. - DATE INSPECTOR'S SIGNATURE - SIGNED THIS DAY OF 19_ - - OWNER-OR NEW HOUSE SEWER OWNERS AGENT' CONNECT ADDITIONAL ADDRESS BUILDI NG OR WORK 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 DRAT NFIELD - • . 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 LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM n CALIFORNIA OR THAT ] AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE D RESID RTY. ABANDON HOUSE SEWER SIGNATURE DESCR, PERMITTESOF �- . BACKFILLSEPTIC TANK ❑ ] ff'V,,,y'T -�-, ,.. ' �a Y SEEP.PITS) ❑ CESSPOOLS ❑ - LIDATION ROBERT A. wood M.O. CASH SUPERVISING G MECHANICAL -ENGINEER CK. - iY tCo 7 9,"0;8-'— DEC` 8 1 0 GEBOB 5-65 76A 642D APPLICATION-ION FOR PERM T " COUNTY OF LOS ANGELES SEWER-SEWAGE [DISPOSAL. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION' BUILDING JOHN A.L'A61ftIF., County Engineer ADDRESS /q�j COLEMAN W. JENKINS,Sup't. of Building, LOCALITY NEAREST FOR APPLICANT TO FILL IN =ROSS ST. go LEGAL " DESCRIPTION LOT NO. OWNER MAIL J ' BLOCK a TRACT y ADD S5� NO. OF BLDGS. SIZE OF LOT NOW ON LOT CIT TEL. •NO. USE OF - BUILDINGS rDISTRICT NO. GROUP MAP PROCESSE BY CONTRACTO �� AODRES CONNECTION DATA STATION DEPTH C YTEL. NO.- ' LICENS r L CENSE UPPER' NO. a` �' CLA 55 MANHOLE REFERENCE NO. DESCRIPTION OF WORK 'FEE TYPE OF CONNECTION LENGT FROM , OUSE, SEWER CONNECTING TO' - Y. CURB P.L. PUBLIC SEWER - C $ 5.00 SEPTIC TANK, SEEPAGE-PIT OR JOB NO. 2 PITS AND/OR DRAINFIELD. C $10.00 CO IMP. NO. O HOUSE SEWER CONNECTING TO - TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM C $ 3.00 CONNECT ADDITIONAL BLDG. OR — ^ AFFIDAVIT I WAIVER EASEMENT RECORD,INSTR.NO. DATE WORK TO HOUSE SEWER C $ 3.00 V 0 ITFTER. RE A R OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM C $ 3.00 - - HWY. OR ST.WIDENING E%TN.,CES SPO.L. MANHOLE C' $ 5.00 STATE ENCROACHMENTA' -I PERCOLATION TEST -C' $ ,5.00 PERMIT NO. (,�'�j /Nt.. INDUSTRIAL r (� WASTE APPROVAL J � OWNERS PERMIT S 2 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WI THE HEREIN AMED CON. REIM BURSEMENT FEE ` TRACTOR TO CONNECT THE ABOVE DE CRIED EXISTI DWELLIN TO THE PUBLIC SE?E - - .APPROVALS DATE INSPECTOR'S SIGNATURE - SIGNED THIS DAY OF 1 _ OWNER OR NEW HOUSE SEWER OWNERS AGENT _ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS - SEPTIC TANK,SEEP,PIT(S) ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS. APPLICATION . AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ WITH ALL COUNTYORDINANCES AND .STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBYCERTIFY THA I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR - LICENSED AS REQUIRED Y LOS ANGLES COUNTY AND STATE. OF SEWAGE DISPOSAL SYSTEM - CALIFORNIA OR THAT M THE EGALOW NEROF, D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB ,DESC ED RESIDENTIAL OPERTY. ABANDON HOUSE SEWER SIGNATURE 'BACKFILL SEPTIC TANKS ❑ OF PERMITTE SEEP.PITS) ❑ CESSPOOLS ❑ _ , VALIDATI CK. M.0. CASH . rz YDEPAIUMENT OF COUNTY ENGINEER SEWER"SEWAGE DISPOSAL DYVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF ]LOS ANGELES -WILLIAM J. FOX/ COUNTY .ENGINEER I BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING /0 17 /„ *�_. CNEAREST ROSS ST. _ �?` ADDRESS / 3 LOCALITY �� DISTRICT NO. pp SERIAL NO, / PER,M`IT NO. NEAREST G� /1 f 6A, C `� CROSS ST. S� i RECEIVED �B.pY, Ready for Inspection DATE ISSUED OWNER .•�.,.'IV" !E'!>C 4��.�g MAIL ADDRESS&� J, r , J� � USE ZONE- OCCUPANCY MAP / .� WL�I/.�dylfg� SK PG CITY / TELAO. /� •/! �Y�( f' '. • ( 1 CONTRACTOR/A _0. a,, / � , .. -CO..IMP.-NO. ADDRESS /" JV . � � ddRlY JOB NO. CITY TEL.NO. TRUNK PERMIT NO. p STATE ' REGISTRATION NO. f "�� E3iZOU'NTYA �. ' ROAD PERMIT N0. LEGAL DESCRIPTION LOT NO. 9 STATE ENCROACHMENT PERMIT NO. -�. _ BLOCK TRACT A09 INDUSTRIAL SIZE OF LOT NO.OF BLDGS. WASTE APPROVAL NOW ON LOT CHARGES USE OF BUILDINGS/l/ �"'Y,yye'��'�,�/��b��y� CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FE PUBLICSEWER @ $ 3.50 'C' RECEIPT NO. I ATE IBY HOUSE SEWER CONNECTING TO ( �� PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDS.OR EXCEPTION RECORDE WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXITING NO I DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION 47 ! %3 DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 ' ( MANHOLE REFERENCE I rLUPPER `L'3.WZ--R TYPE OF CONNECTION LENGTH FROM `Y.-a 'CU'RB P.L.4"- M.L.TO P.L. OWNERS PERMIT $ I 00 AUTHORIZATION TOTAL FEE 1 HAVE THIS DATE-CONTRACTED WITH THE HEREIN NAMED. CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING! APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC-SEWER j J/ SIGNED THIS....................DAY OF........................................I9...—..., NEW HOUSE SEWER �v eq OWNER OR' CONNECT ADDITIONAL OWNERS AGENT------------------------------------------_•-- ------....... ........ BUILDING.ORWORK ________________________________-.____-.__ SEPTIC TANK,SEEP.PIT(S) ADDRESS ----------- -------------------------- . -AND/O R D RA I N F I E L D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL E] DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE' TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR . REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ' DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY' ABANDON HOUSE SEWER. AND STATE.OF CALIFORNIA OR THAT I AM THE LEGAL OWN ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTICTANKS E] SIGNATURE �, SEEP.PIT(S)El CESSPOOLS 1:1 OF^PERMITTEE..._ � � i !?3:"r t` `, L ` 76A642D 663 1/53 f _ s�''wr - �