HomeMy Public PortalAbout9519 LOWER AZUSA RD_Sewer__ 74AC42D
CE808.8-58 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Aa
UILDISSNG
V ?
DDRE
JOHN A. LAMIL County Engineer
CASSATT D. GRWTIN,Supt of Building LOCALITY
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRIESS,I"J-;,
ITO.OF BEDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OF
—BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR BK PG A,—)
ADDRESS
CONNECTION
CITY TEL.NO. STATION DEPTH
TATE
R0"0. COUNTY MANHOLE UPPER
EGjSTRA
— T, FEYIC&, LOWER
.NO. I TESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER a $3.00 0
SEPTIC TANK,SEEPAGE PIT OR TYPE.F CONNECTION LEN GTif FRDM'
PITS AND/OR DRAINFIELD @ $3.00 Y. -'�_CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOO L,DRYWELL,MANHOLE $2.00
HOUSE SEWER CONNECTING TO P . O, Vf
PRIVATE DISPOSAL SYSTEM $1.00 CO.IMP.NO. No.
CONNECT ADDITIONAL BLDG.OR
WORK 10 HOUSE SEWER $1.00 TRUNK PERMIT NO, ROAD 2��T No.
ALTER R OR ABANDON HOUSE
SEWERREPAIR STATE ENCROAeMMENT
OR DISPOSAL SYSTEM $1.00 PERMIT N21�
L
INDU 'AL
APPROVAL
CHARGES
Ovmws PERMIT s 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE I ?L I j REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THISDAYOF NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Ljj DRYWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY.-THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUtAgD BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM- THI� LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENftIAL PJR OPE4 BACKFILLfTIC TANKS
SIGNATURE
SEEP.
PIT
0 CFS' 0❑OLS❑
OF PERMIT
"'VALIDATION ROBERT A.WOOD
H.0. cum SUPERVIS114G MEC4-iANICAL ENGINKIER
DEPAUTN E_NT OF COUNTY ENGINEER
' DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
COUNTY OF LOS ANGELES PERMIT APPLICATION
WILLIAM J. FOX. COUNTY ENGINEER I BUILDING
ADDRESS " �p� -2,
FOR APPLICANT TO FILL IN LOCALITY��
BUILDING 9 NEAREST
AD �'C �tJ�, (�/f�( �r .. j CROSS ST. ,
ORERS
LOCALITY , y i' DISTRICT NO. SERIAL NO. PERMIT NO.
�,�. A lQ h 4 'E
CROSS ST. ,�/l��I Zen)
IVED BY Ready for Inaveotion DATE ISSUED
OWNER 62& ,�Lp/l/L1� q * ,Z�Za�J3
ADDRESS � o Ms, e�.P USE ZON OCCUPANCY BK MAP PG
CITYTEL.N0.
1
CONTRACTOR 1/,V, 4)}.��' % w _�:�t:�- � r�'�i CO.IMP.NO. -
ADDRESS ��. L_ tyOLA-4a►_., JOB N0.
CITY TEL.NO. � TRUNK PERMIT NO.
REGISTRATION NO.�,?.//.g �+ STATE ROAD PERMIT N0. �`r 5-n O3
TUNTy-
LEGAL .� STATE ENCROACHMENT
DESCRIPTION LOT NO. r! PERMIT NO.
BLOCK TRACTINDUSTRIAL
-- WASTE APPROVAL-
SIZE OF LOT,�lG +2 0` NOW ON
LOTS CHARGES
NO.OF BLOG _
USE OF
BUILDINGS s CONNEC CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO .y REIMBURSEMENT
PUBLIC SEWER S 3.50 O RECEIPT NO. ATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORD
WORK TO HOUSE SEWER• 1.00
ALTER OR REPAIR EXISTING NO- DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 I
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC PITS AND/OR DSR INFGELDIT OR • 2.00STATION DEPTH
CESSPOOL—DRYWELL , � I
SPECIAL CONDITIONS ONLY 2.00 I @N.II`OLE REFERENCE
j�r()WER)
TYPE OF-011111RECTIONLENGTH FROM
OWNERS PERMIT I 00 M.L.TO P.L. 3
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PU LIC SEWER/
SIGNED THIS DA SOF... _. =19J NEW HOUSE SEWER Sa.
OWNER OR /1�jJ� y }' CONNECT ADDITIONAL
OWNERS AGEf�TN_L-- �. !L�i `:!''��.;_:?:L_� BUILDING OR WORK
SEPTIC- f SEPTIC TANK,SEEP.PIT(S)
i- �-.-- r - AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ 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
I HEREBY CERTIFY THAT 1 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 SEPTIC TANKS
SIGNATURE �-�` SEEP.PIT(8)� CESSPOOLS �'�lrJ 4 G
OF
PERMITTEE.;;? le-
+r_ ,e '_ G •_'. _=...
76A642A 668 7/53Q�' _,�/„ry,�J,,r,� �.�'