HomeMy Public PortalAbout5724 NOEL DR_Sewer__ CE808 s 84
78A842D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINM
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAM M County EnyInear ADDRESS
WILLIAM A IENSEN Sup t of Bluklmg
LOCALITY
NEARECROSS ST AA
AL ST
FOR APPLICANT TO FILL IIsi
L O
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT ADDRESS
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF DISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS
CONTRACTOR w� 0s, / TB~ P.G
ADDRE � CONNECTION DATA
7 0 7O STATION DEPTH
CITY TEL NO
TATE MANHOLE REFERENCE UPPER
REGISTRATION NO44 ' COUNTY LOWER
NO DESCRIPTION OF WORK FE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTI NO TO Y CURB PL ML TOP L
PUBLIC SEWER f8 00 PC N
SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO O
PITS AND/OR DRAINFIELD $1000
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO U
PRIVATE DISPOSAL SYSTEM ® $300
CONNECT ADDITIONAL BLD. i AFFIDAVIT MAIYNN AAN[NANT RECORD INSTR NO DATE O
ATO HOUSE SEWER f9 00
OVERFLOW SEEPAGE PIT DRAINFIELD (]
EXTN CESSPOOL DRYWELL MANHOLE! 53 00
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING y
SEWER OR DIBP SAL SYSPM e $300 TATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNER S PERMIT S 2 00 C ARGEB
AUTHORIZATION TOTAL FEE 10101 op
CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR B SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING h
ADDRESS SEPTIC TANK SEEP PIT(8)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
1 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 THEA VE DESC ED SIDENTIAL P OPERTY
,. ABANDON HOUSE SEWER
SIGNATURE s 1t/' _ BACKFILL SEPTIC TANKS ❑
OF PERM ITTEO ��V I��o SEEP PIT(8) ❑ CESSPOOLS
ATION ROBERT A WOOD
CK M Q CASH SUPERVISING MECHANICAL ENGINEER
(ACo7837QDEC 610D 5.00,- 9
D
B&Z0622
APPLICATION FOR PERMIT 1
DTi/ISION OF BUMDMG AND SAFETY SEWER—SEWAGE DISPOSAL
D"Wtn an! Of Conatp 8nglneer
Cp7fn{t Los Angela6 >3U14D)N
WM J FOX COUNTY ENGINEER ADDR S
CASSATT D GRIFFIN Sup t op HuN.D1N0 LOCALITY f jl�-L j
FOR APPLICANT TO F= IN NEAREST
CROSS ST
LEGAL #V4
O
DESCRIPTION LOT AO /fi a OWNER
pm OF
BLOCK TRACT MAIL
ADDRESS
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITY J7-L TEL NO Ito
USE 41
BUILDINGS w �` C DISTRICT NO
GROUP MAP G
CONTRACTOR i S S ,
ADDRESS 1 A G CONNECTION DATA
CITY 04C TEL NO 10 � $ STATION 3 DEPTH '
�y STATE jV
• --46PPERL
REGISTRATION NO
�r/ �J [3COUNTY MANHOLE REFERENCE
No DESCRIPTION OF WORK FEE
HOUSE SEWER TYP CURBECTIOS! LENGTH FROM
PUBLICSEWER CONNECING TO ® S 350 ! M L TO P L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG ORP C NO
WORK TO HOUSE SEWER 100 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING TRUNK PERMIT NO ROAD PERMIT NO 01d z
SEWER OR DISPOSAL SYSTEM too
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 PERMIT NO
SEPTIC TANKSEEPAGE PIT OR INDUSTRIAL
PITS AND/OR DRAINFIELD 00
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 200 CHARGES
OINNWS PEI{ CONNECTION CHARGE FEE
S 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEEIHAVE � "C\
TRACTORTHIS DATE TO CONNECTOTHEACTED ABOVEWITH THEDESCR BED EXISTINGDWELLINGAPPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THI NEW HOUSE SEWER DAY OF 19 Z
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
JEWSEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACK LEDGE 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS[3SEEP PITS CESSPOOLS "Z
SIOF PERMITTEE
WILLIAM J FOX.COUNTY ENGINEER VALIDATION R A WOOD CHIEF PL.90 INSPECTOR
1 N
c r