HomeMy Public PortalAbout9942 NADINE ST_Sewer__ 78A K--663 11-155APPLICATION FOR PERMIT - 1
DMSION OF BUILDING AND SAFETY SEW E R—SEWAGE DISPOSAL
De"Irhaent of County Engineer
County Of Los Angeles A
DDRESS G Z �cZ
JOHN A. LAMBIE, COUNTY ENGINEERin
M CASSATT D.GRIFFIN, SUP'T OF BUILDING Y
FOR APPLICANT TO FILL r.
LEGAL
DESCRIPTION LOT NO, OWNERMAIL
BOCK TRACT ADDRESS �ri fir
NO.OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ONILOT
USE OF
DI / DISTRICT NO. GROUP MAP
BUILDINGS
BK P6
CONTRACTOR
ADDRESS
CONNECTION DATA
/ .1
STATION DEPTH
_44CITY t TEL. NO. h MANHOLE REFERENCE / , UPPER
❑ ST,6E
REGISTRATION NO. ([� � ❑ COUNTY
NO. DESCRIPTI N OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ S 3.50
CURB P.L. M.L.TO P.L. 546
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0,
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB N0:
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @• $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ S1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OMMIS PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INS ECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER D
SIGNED THIS D Y OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS, wY AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ELES COUNT AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT T LEGAL 0 OF ABOVE
DESCRIBED RESIDENT P BACKFP T(SEP❑ TIC CESSPOOLS- -
0S❑
SIGNATURE SEEP
OF PERMITTEE
JOHN A.'LAWME.COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PL.BG. INSPECTOR
. CK. U.
JiL05 3 9 2S BEC27 4 4.50
8 C-6 33.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D 1 S POSA L
Enginew
qty of Los Ang FADDRESS
G 2
WM.J.FOX.COUNTY ENGINEER AfCASSATT D.GRIFFIN,SUPT OF BUILDING YO P C TO FILL,
CROSS ST.
LEGAL • •
DESCRIPTION LOT NOA 00 OWNER
BLOCK TRACTHAIL
ADDRE S
SIZE OF LOT NOWOONBLOT3 CIT I TEL.NO
S145,
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
QK_
PG
CONTRACTOR `JTZ 1
ADDRESS CONNECTION DATA
CITY TEL. NO. STATION Q Q DEPTH
❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER
S H SO Y. CURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR P.C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOB N0.
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 INDUSTRIAL
PITS AND/OR DRAINFIELD 00
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OEWS pE1 CONNECTION CHARGE FEE 3 �
S 1 00
AUTHORIZATION I 'TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE TTO CONNECT THEHIS DATE AABOVECTED WDESCR BED EXIITH THE STING DWELL MG IN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19-
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
LDESCRIBED
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
MBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
IFORNIA OR THAT t Atl THE LEGAL OWNER OF THfi ABOVE ABANDON HOUSE SEWER
RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
CESSPOOLSNATURE
F PERMITTEE CA.. -
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF FLBG. INSPBCTOR
�o 2 9 1U DEC 23 3 9 4 7.25 • -9