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HomeMy Public PortalAbout9811 MILOANN ST_Sewer__ y 6A 642D —CE808—10-71 APPLI CAON FOR - RM IT COUNTY OF LOS ANGELES SEWER—S WAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION F NG SITYST FOR APPLICANT TO FILL IN ST. /l 'A4 LEGAL -77 y� DESCRIPTION LOT NO. OWNER __.. .//]�� / MAIL BLOCK_ TRACT / „�C3 ADDRESSNO. OF SLOGS. SIZE OF LOT,22- 7L /Y NOW ON LOT CITY � C 1 TEL. NO. USE OF BUILDINGS DISTR ICT NO. UROUP - MAP CE SSED BY BK CONTRACTOR - .�[)✓>,l JIJ S •�/ % / /J''`' .ADDRESs �r C i.LI ( ]� `°/" °'C:61 ji. CONNECTION DATA _ CITY �. TEI. NO. L STATIO DEPTH UPPER Al STATE 1 LIC MANHOLE ERENCE LICENSE NO:, _ GLASS C­ LOWER NO, I DESCRIPTION OF WORK FEE TYPE OF CONN TJON LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB - ^R. M.L.TO P.L. PUBLIC SEWER @ $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR __f PITS AND/OR DRAINFIELD $10.00 CO.IMP,NO. �J�NO. -- w HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PER T NO. 0- PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL 4YON.bR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE V WORK TO HOUSE SEWER @ $3.00 4+ OVERFLOW SEEPAGE PIT,DRAINFIELD _ EXTN..CE55POOL.DRYWELL, $5.00 ALTER.REPAIR OR ABANDON HWY.OR ST.WIDENING HOUSE 0 SEWER OR DISPOSAL SYSTEM @ $3.00 - —'-- V --- - - STATE ENCROACHMENT MANHOLE �7 00 PERMIT NO. INDUSTRIAL t/) WASTE APPROVAL Z_ OWNERS PERMIT $ 3 00 CHARGES AUTHORIZATION I TOTAL FEE loo CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ����ee TO THE PUBLIC SEWER. APPROVALS DATE INSPkC.OR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER t a OWNERS AGENT CONNECT ADDITIONAL ADDRESS_ BUILDING OR WORK ' _ SEPTIC TANKS PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELfEL D AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS_ CESSPOOL Cl DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRI D RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE /' OF PER MTTTEE_ BACKFILL SEPTIC TANKS ❑ —" SEEP.PIT(5) a---J�ESSPOOLS ❑ VALIDATION 4 CK. M.O. CASH 1D < cr ,c5 . 0 6.00 ,ftt�, OEPAIC MENT OF COUNTY ENGINEER SEER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILD`,NG ADDRESS FOR /� Pl,� T T FILL ifs LOCALITY SUILI)ING ' NEAREST ADDR57SS CROSS ST. _ LOCALITY ° DISTRICT NO. SERIAL NO. PERMIT N0. NEAREST " 'r CROSS ST: _-- RECE9VED BY } Ready for Inspection DATE I sSUEn OWNER MAIL ADDRESS USE Z NE OCCUPANCY Ir7a?P SK PC B CITY TELAO. I r CONTRACTOR z� ; �`�' v� CO.IMP.NO. ADDRESS y� Y , -. ------ -- - `g 2 z J013 NO. TRUNK PERMIT NO. - -. -- REGISTRATION NO. � OUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. STATE ENCROACHMENT - PERMIT NO. BLOCK TRACT INDUSTRIAL 1l` - WASTE APPROVAL SIZE OF LOT NO.OF SLOGS510 . __ - - NOW ON LOT CHAR USE OF~ s e� — BUILDINGS � y+" a " CONNECTION CHARrE FEE NO. DESCRIPTION OF WORK FEE _ REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO � -- PUBLICSEWER @ $ 3.50 `` ` RECEIPT NO. DATE - !BY HOUSE SEWER CONNECTING TO � }' PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 �I ALTER OR REPAIR EXISTING NO. DATE I BY f SEWER OR DISPOSAL SYSTEM 1.00 } _ { �iDISCONNECT AND ABANDON SEWER �( ANDjOR DISPOSAL SYSTEM I.©0 I —� CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 -! mMANP41" E PFFERENCE UPPER TYPE OF CONNECT3k, LENGTH FROM OWNERS PERMIT ; 1 00 Y. culls P,L. M.L.To P.L. AUTHORIZATION TOTAL FEE _ J4 1 -- I 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 - SIGNED THIS..__. _.DAY OF.. ...Imo-' NEW HOUSE SEWER Y. OWNER OR CONNECT ADDITIONAL I OWNERS AGE ........._. BUILDING OR WORK ADORES, -.__ ------ .__... SEPTIC TANK,SEEP.PIT(S) _ _-"- _•..-.._ ANO/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DFRYWELLrl 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 AMB PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REO 013 T A- LOSTH ANGELES COUNTY ABANDON HOUSE SEWER AND:STATE OF CALIF -NIA OR TH 1 AM THE LEGAL OWN- ER OF THE ABOVEDEVORIBED MWDIENT PROPERTY. BACKFILL SEPTIC TANKS[j _. SIGNATURE sEEP.PIres Q CESSPOOLS p W'�( OF PERMITUT€ 7eA642A 663 7/5' PdXere ,