HomeMy Public PortalAbout5822 OAK AVE_Sewer__ CEAG4 5 5s
7 6A 842D APPLICATION OR PERMI
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION FRE
Sgaa A
JOHN A LAMBIE County Engineer AK AUf-_NLkjE
COLEMAN W JENKINS Sup t of Building
��FOR APPLICANT TO FII. IN
LEGAL S, S
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT �/ ADDRESS
SIZE OF LOT O JC �l �+ NOW ON LOTS CITY01 L.G " TEL NO .2,s4
USE OF ` ' ^ ��+
BUILDINGS v (� / DISTRICT NO GROUP MAP PROCESSED BY
CONTRACTOR f , S I O / P` -
ADDRESS 40WU CONNECTION DATA
TEL NO STATION DEPTH
CITY
NO
LICENSE CLASSSE s C-a, MANHOLE REFERENCE S
LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNEC ION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L ML TOPIL
PUBLICSEWER @ $ 5 00
It T
AbtriN E PC NO
PITS AND/OR SEEPAGE
C $10 00 CO IMP NO ` JOB NO O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V
PRIVATE DISPOSAL SYSTEM @ $ 3 00
CONNECT ADDITIONAL BLDG OR AFFIDAVITT71[AB[II[IIT RECORD INSTR NO DATE
WORK TO HOUSE SEWER 0 $ 3 00 O
H �(+
SEWER OR DIS PO C $ 3 00RAINFILLU
HWY QRST WIDENING
E%TN CESSPOOL MANHOLE P $ 5 00 h
STATE ENCROACHMENT Z
PERCOLATION TEST S $ 5 00 PERMIT NO
INDUSTRIAL
`=
��p WASTE APPROVAL
OWNER S PERMIT E 2 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION FTOTAL 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 SEW jj,, APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS_pL1f�DAY OF 191
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
HEREBY ACKNOWLEO E THA HA READ THIS APPLICATION SEPTIC TANK SEEP PIT(S)
4AD STATE THAT THE ABOVE IS CORR T AD GREE TO COMPLY AND/OR DRAINFIELD
NA
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 IAM THE LEG OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABO DEBC IBE R IDENTIAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTE SEEP PIT(S) ❑ CESSPOOLS ❑
VALIDATION
(sl
K M O CASH
LAZOO AUG221 0 D 500N v
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R66a I2 sa
s a e asAPPLICATION FOR PERMIT 1
DNMON OF SUWRIG AND SAFZ"1'Y SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
WM J FOX COUNTY ENGINEER ADDRESS
y CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
DESCRIPba
TION LOT NOQ I_ ,( 7&Q
OWNER
BLOCK TRACT44 MAIL
NO OF SLUGS ADDRESS
SIZE OF LOT N W ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP YAP
� BK PG
CONTRACTO . . M O. ��
I L I
ADDRESSire) T Ic-/..r e- /p. L PY CONNECTION DATA
CITY ph TEL NO �y 7 6 f' STATION ? J— DEPTH d
^
lit-STATE MANHOLE REFERENCE
REGISTRATION NO ! E3 COUNTY UPPER LOWRW
TYPE OF CONNECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE cuRe4w M L TOPI.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER S 350
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CON ECT ADDITIONAL
WORK TO HOUSE SEWER BLDG OR 100 '� CO IMP NO / JOB NO
ALTER OR REPAIR EXISTING !�! F O
SEWER OR DISPOSAL SYSTEM too TRJNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM too PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 200 CHARGES
CONNECTION CHARGE FEE
O%vm S PERMIT a 00
AUTHONUTION I TOTAL FEE I10 REIMBURSEMENT FEE
TRACTOHAVERTHIS DATE TO CONNECTONTRACTED THE ABOVEWITH THE DESCR BED EXISTINGAMED CON DWELLING APPROVALS ATE INSPECTOR SIGNATURE
TO THE PUBLIC EW R
SIGNED THI DA 19j"
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGE BUILDING OR WORK
SEPTIC TANK SEEP PITS)
ADDRESS AND/
DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL E3ORYWELL
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 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY BACKFILL SE C TANKS E3SEEP PIT 8 CESSPOOLS
SIGNATURE
OF PERMITT
WILLIAM J FOX Ccuw6 ENGINEER VALMTION
By &7 3 34 0S AUG31 4 65 0
DEPUTY DEPUTY
BY eY �
0 DEPUTY �"Ood DEPUTY