HomeMy Public PortalAbout9911 MILOANN ST_Sewer__ 71ED
& ,663 l2.54 APPLICA► ■ IVN FO ■ PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Arageies BUILDINGDDRESS
VdM. J.FOX, COUNTY ENGINEER _
CASSATT A.GRIFFIN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TOFILL IN NEAREST
LEGAL _ EO S ST.
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DESCRIPTION— LOT NO, OWNER '°'gi- �"^^`'`
BLOCK TRACT �C - MAIL 9, _
ADDRESS. 4,
N0.OF BLDGS, f
SIZE OF LOT �NOY_!ON LOT f CITY _ TEL. NO.
US£OF _
BUILDINGS b' _%4._
DiSTR[CT.N GROUP i YAP
w 1
CONTRACTORr �L'PK-fir -- �e
ADDRESS ' T. 3• F � �s e�a�rCONNE{C,,...TION DATA
CITY �.^ -'g`-� L ' T£L. N0. 1,, ;a" *^^'-,a�l./ STATION ,."' `" (,.� t .„„JP DEPTH .
L7 STATEFER
�e R F_NCE
REGISTRATION NG. ,,--_ "_ 46r -'J Y _-� .I F '�P; :✓t.� PER r` LOWER--
^ •u ''^N TYPE OF CONNECTION LENGTH FROMNO. ! DESCRIPTION Or WORK FEE Y. CURB P.L.
HOUSE SEi'ER CONNECTINC TO
, �-PU6LIC SP4J ER _ $
i
HOUSE EN/kR-ONhECTItiC TO
PRIVATE D SPOSAL SYSTEM 1,00 i --- ---
rGNNECi AUceTfON.AL BLDG. 0 -- 1— - IMP. N0. ('' � JOB. NO.
h PK TO HOUSESEWER
_
1,LTI ER? OR'REPAIR EXISTING
E'!rR OR DISPOSAL SYSTEM _ 5 00-I 'R �PiK PERMIT N0. ROAD PERMIT NO ,
CHSCON`LCT AND ABANDON SEWER -- '- —`—. -
9PvC�`QR DISPOSAL SYSTEM 1 00 NAME ENCROACHRfENT
SEPT .
.C BANK, SEEPACE PIT OR .-.. _�_--'. �.-�---.vs.._----- --,.----.
PITS AND/OR DRA NF ELD 2 00 j INDUSTRIAL � -`
—� CFS P--- D..3YW ELL
SPE -__�— - --:. '.NASiE APPROVAL
SL,
CONDITIONS ONLY 2.00 i CHARGES
CONNECTION CHARGE FEE
�T
Ow I'ER'S - ---?$E RIMIT $ -.�1 On ---
AUT IOBg Aal 3Tgi TOTAL FSE J ' REIMBURSEMENT FEE
I HAVE THTS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED T HIS DAY'` 1S—__. --- _ ---
OWNER OR - `�l', CONNECT ADDITIONAL
0`,{NERS AGENT _C_U[LDING.OR WORK W _
SEPTIC TANK, SEEP, PIT(S)
A6CRESS_ - _ AND/OR DRAINFIELD _ -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL E] DRYWELL 0
AND STATE THAT THE ABOVE IS CORRECT .AND AGR�.E TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR—
PLUNiBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REG.iSTERED AND/OR "—
L?TENSED AS REQUIRED BY LOS ANGELES CCUN7X AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR T14AT I AM THE LEGAL OWNER OF TIIE ABOVE _ABANDON HORSE SEWER _
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 0 —
a
SEEP.PITS) 0 CESSPOOLS 0
SIGNATURE 0
OF PERMTTTE '
WILLIAM J.'FOX. COUNTY ENGINEER VALIDATION
By
DEPUTY DEPUTY
BY BY {P; ?°
DEPUTY DEPUTY
G�q1
E998 16...83 !
6A.642iD APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES �
SEWER-SEWAGE DISPOSAL
DtPARTMENT OF COUNTY ENGINEER
-'
BUILDING AND SAFETY DIVISION TNEARE
LWN ,T R
O REss
JOHN A. LAMBIE, County Engineer - -� ----- --————
WILLIAM A. JENSEN, Supt of Building
LCCALITY
T
FOR APPLICANT TO FILL IN 55 5T
-"CrGAL Z'-Nt�pj✓..."� "�S.dr�7 -?`�! .sem OWNER
DESCRIPTION �` � -
,/^ MAIL 7 333 q� .
BLOCK TR.P.^7 { .' ACDRESS ¢ ;, X 0,
�. NO. OF BLDGS. „ r.�:
SIZE O LITY,- FC NOW ON LOT TEL. NC}:_-__yP, y` s
USE OI DISTRICT NO 0RC3UP MAP PROCESSED BY"
r'. SK
2 _.
CONTRACTOR t'-- _ j
ADDRESS CONNECTION DATA
STATION DEPTH
CITY TEL. NO.
T
EJS ATE MANHOLE REFERENCE UPPER---
REGISTRATiON. NO ❑ COTI N1 LOWER
NO. ! DESCRIPTI^.N OF WORK FEE _ TYPE OF CONNECTION LENGTH FROM
F!6US€:SEWER E6NNECTING TO r Y CUR® P.L. M:L TO P.L.
PUBLIC SEWER $5.00
_ P.C.NO
SE TiC TAMS,SEE:AGE PI7 OR CO IMP NO. JOB NOy
PTS AND/OR DR.AINFIELD C $10.00
HOUSE SEWER L?N NECYING.70 TRUNK PERMIT NO. ROAD PERMIT NO. �
PRIVATE DISPOCAL SYSTEM $$3..00 _ -N
,._
C QNNEG VCD ON Ai - AFFIDAVIT WAIVER EASEMENT I RECORD. INS7f2 N0. ; DATE ..
I WORK TO HOUSE SEWER t- $3-00
OVERFLOW SEEPAGE PIT,DRAINFIELD -
EXTN„CESSPOOL.DRYWELL.MANHOLE.C $9.00 g
_ HWY.OR ST.WIDENING
�AL TER.RF-PAIR OR ABANDON riOUSE I.
SSW ER OR DISPOSAL SYSTEM $3.DO —.--._ ._.._ ..-
-_..- STATE ENCROACHMENT
.. -- j PERMIT NO. ..
INDUSTRIAL
i WASTE APPROVAL �.�:...-. - �...
� CHARGES
OWNERNS PERMIT -
"--"---'--'--' - -- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
REIMBURSEMENT FEE
'1 HAVE AT THIS DATE A, CONTRACTWITH THE! HERE'N NAMED CON- ---- - ---- -—
TRA.CTOR "YO ('ONNEC', THE ABOVE DESCRIBF0 )EXISTING DWELLING NG -- �-l---'p—��-'++- - -"t— ----- -- -TO T i_ ?US IC SEWEr, ,.., �,F� APPR®Y ALE.7 DATE i INSPECTOR'S SIGNATURE
SiGNFD ?'His G1AY OFd —"'---
OWNER
r NEW HOUSE SEWER
7W^7 R AC'ti'p T �_,.��;..� �" �. '^E.�.�F"� _.— CONNECT ACC7d710PdAC. !.. -
f, ..
BUILDING OR WORK
- - --- STI^ TANK.SEEP P!T{S)
s FRE.Br A N
} .OWLEOGE THAT ( HAVE R AD THIS APP CAT IQN NL'DR DRAINFIELD
AND STATE THAT THE ABOVE. is CORRECT AND. AGREE TO - -
WfTH )
ALL COI I NTY DRDINA.NC�ES AND STATE' LAWS REGULATING
ING .AND SEW_RS. C�SSPOOL [71pRYW ELL ❑
I HCERTIFYREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND) ALTER REPAIR,SEWER OR
C''NS,FD AS REQ ! ED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CA L.'FORNiA. OR TMA AM THE LEGAL OWNER OF AN6�INTEND TO DSc:.ONNL CT PLUG AND
YcF>IDE IN, TNF ny,Fgy' Dt CRi:9ED iC3ENT1 A4. PRQ'�'ERT'Y. ABANDON HOUSE SEWER j
S!GNATIJRE r� ..r' d __— --_ ._.. .. ____❑ _.�-J-- _
OF PERMITTEE '4 a-�.R'�..- BACKFILL SEPTI..TANKS
"ti' -�`' '.J.—"-�` ""'- - SEEP,PITS) ❑ CESSPOOLS
VALIDATION ROBERT A. WOOD
CH. M.O. CASH
SUPERVISING NIF_CHANICAL 'ENGINEER
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