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Home My Public Portal About9582 LOWER AZUSA RD_Sewer__ r D B&H695 APPLICA'T'ION FOR PERMIT _ s°g e DIVISION OF BUMDMG AND SAFETY S EW E EWAG E D I S POSA L Department of County Engineer County of Los Angeles BUILDING +� WM J. FOX, COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN,SUPT of BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST Qui LEGAL DESCRIPTION LOT NO �/�T� OWNER � BLOCK TRACTr+'7j�9 Q MAIL ADDRESS NO OF BL GS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP BK PG CONTRACTOR ADDRESS 3 CONNECTION DATA CITY/ NO NO � STATION DEPTH L ["TATE MANHOLE REFERENCE UPPER REGISTRATION NO , Z 3 ❑ COUNTY LOWER NO DESCRIPTION OF WORK FEE '-TYPE OF CONNECTION LENGTH OM HOUSE SEWER CONNECTING TO Y CURB P L M L TOP L PUBLIC SEWER Q S 3 50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM too CONNECT ADDITIONAL BLDG OR P C NO WORK TO HOUSE SEWER 1 00 CO IMP 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 AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL-DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNER'S pT s 1 00 AUTHORIZATION I TOTAL FEE 1 Iry REIMBURSEMENT FEE TRACTORTTOSCON ECTDATEOCTED THEAABOVEWITH DESCR BED EXITHE STING DWELLING APPROVALS DATE INSrECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ NEW HOUSE SEWER (c � OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK 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 IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ SEEP PITS CESSPOOLS SIGNATURE OF PERMITTEE If -+ JWILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A WOOD.CHIEF PLBG. INSPECTOR ��930OUR OCT 24 4 2.00 10 ,0.82 76AG42D APPLICATION FOR PERMIT 78A84 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIBISIONBUILDING7777— iOHN A LAMBIE County En eer ADDRESS WWIILLIAM A IENSEN Supt of Building LOCALITY � Ed NEAREST FOR APPLICANT TO FILL IN CROSS0-c jpe 4m LEGAL DESCRIPTION LOT NO 02 zZ OWNER MAIL BLOCK TRACT ADDRESS NO O L BDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS oe DISTRICT NO GROUP MAP PROCESSED BY /j ��{{ P G CONTRACTOR _Jpjg 4/�U 1 ADORES V9.0Ryle CONNECTION DATA STATION DEPTH CITY TEL 190onr STATE MANHOLE REFERENCE UPPER REGISTRATION NO COUNTY LOWER NO DESCRI ON OF O FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TOP L PUBLIC SEWER S3 00 PC NO SEPTIC TANK SEEPAGE PIT OR O PITS AND/OR DRAINFIELD @ $10 00 C HOUSE SEWER CONNECTING TO R N M O A P IT NO PRIVATE DISPOSAL SYSTEM 3300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wlllv[N [•5[N[NT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM 40 $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL - ,� ?-(,A"�0 3 OWNER'S PERMTf $ 2 00 CONNECTION CHARGE FEE CHARGE Ir AUTHORIZATION TOTAL FEE 1 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 INS ECTRR 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 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 I AM PROPERLY 0ISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES UNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA ORETHAT I M THE LEGAL OW ER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THA DE D RES D NTIAL PROPER ABANDON HOUSE SEWER ` SIGNATURE _ / ❑ OF PERMITTE ♦ V BACKFILL SEPTIC TANKS SEEP PIT(S) ❑ CESSPOOLS ❑ I� VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH S 77 6Q AM 12 1 0 0 5.0 C?n q