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Home My Public Portal About5828 OAK AVE_Sewer__ CEBOB 5 Bs 7 BA 642 D APPLICATI FOR P RMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION F.. G JOHN A LANBIE County Engineer S COLEMAN W JENKINS Sup t of Building .r �` Y 1EM PL E, T FOR APPLICANT TO FILL IN BY LEGAL �� '�G DESCRIPTION LOT NO OWNER J MAIL BLOCK TRACT Q(Q^.549I ADDRESS I i SIZE OF LOT 6O 1L 17(=WOON LOTS CITY TEL NO a USE OF I '� DISTRICT NO GROUP MAP PROCESSED BY BE ILJ CONTRACTORIC& r/�4.C�/ S �y� PT BK /v� ADDRESS �r77�`llJF�y 1 y CONNECTION DATA CITY TEL NO �y�� STATION �� DEPTH NO LICENSE ICE/� A CLASS SC�pL.� MANHOLE REFERENCE �`� UPPER V .#L LOWER NO DESCRIPTION OF WORK FEE TYPE OF TION LENGTH FROM PURL C 9EWEER`ONNECTING TO @ $ S 00 Y CU)R P L ML TO P L B CO IMP NO �( JOB j a� O. -TE-EPAIr-M OR PITS ANDA/OR DRAINFIELD C $10 00 ^ HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO VX PRIVATE DISPOSAL SYSTEM P $ 3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVERSASSMSRT RECORD INSTR NO DATE WORK TO HOUSE SEWER C $ 3 00 SEWER OR DISP0 S OSA L2 $ 3 00 0-0 HWY ORST WIDENING EXTN CESSPOOL MANHOLE S $ 5 00 STATE ENCROACHMENT h PERCOLATION TEST P $ 5 OG PERMIT NO Z INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S 21 CONNECTION CHARGE FEE CHARGES AUTHOMATION I TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLICSEWE „� APPROVALS DATE INSPECTOR 8 SIGNATURE SIGNED THIS DAY OF 1,W OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS - BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT HA READ THIS APPLICATION SEPTIC TANK SEEP PIT(S) AND STATE THAT THE ABOVE IS CORRE AND AGREE TO COMPLY SAND/OR ORAINFiELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ ORYWELL ❑ 1 HEREBY CERTIFY THAT I 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 LX4.AL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE E DE C DE 'OPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS E3OF PERMITTEE, SEEP PIT(S) ❑ CESSPOOLS ❑ VMATION M O CASH 0 2 1 OE,,- AuG22 1 0 D 5 00Nto DFPAF-TMENT N VPOIINTY ENOMEER I SEWER—SEWAGE DISPOSAL DMSION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES p ' WILLIAM J FOX, COUNTY ENGINEER I pDDREI88 �O FOR APPLICANT ATO FILL IN LOCALITY /' Q BUILDING _^ ��_o/iJa y6 + GROSS 8T .0% ADDRESS ADDRESS LOCALITY 77 L DISTRICT NO SERIAL NOOQ� CPERMIT NO NEAREST + �(p(aQ o //d7 �O s CROSS 8T RECEIVE BY Ready for Inspection TE 1 UED OWNER �! up ADDRESS ��? 04,& � USE ZONE OCCUPANCY BK YAP PB CITY Tz c TELHO CONTRACTOR CO IMP NO ADDRESS x JOB MO CITY EL NO !/ TRUNK PERMIT NO REGISTRATION NO COUNSTATTY ROAD PERMIT NO LEGAL STATE ENCROACHMENT DESCRIPTION LOT-; PERMIT NO BLOCK TRACT �,j �� + INDUSTRIAL WASTE APPROVAL SIZE OF LOTsQ O NOW ON LOTS CHARGE USE BUILDDINGS letEUIA 94 ;1007-e- CONNECTION CHARGE 4E NO DE9CRIpTION Or WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER ell 359 RECEIPT NOI DATE I BY HOUSE SEWER CONNECTING TO J PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR EX7 PTIO ECORDED WORK TO HOUSE SEWER 100 0 NO ALTER OR REPAIR EXISTING DA BY SEWER OR DISPOSAL SYSTEM 100 AND/OR DISPOSAL ABANDON SEWER 100 CONNECTION DATA SEPTIC TANKSEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION Q DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 MA PP EFERENCR i . TYPE O CU CTION LENGTH TO P L FROM OWNERS PERMIT ; I 00 AUTHORIZATION TOTAL FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT UC THE VE DESCRIBED EXISTING APPROVALS INSPECTOR 8 SIGNATURE DATE SIGNED THIS_r DAY OF 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ _ . _ _ _ _ _.._ _ BUILDING OR WORK SEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL I] DRYWELL CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND DISCONNECT PLUS AND/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY ABANDON HOUSE SEWER AND AND STATE OF CALIFORNIA OR THAT 1 THE LEGAL OWN ER OF THE ABOVE.JkFSCBIBED RE81D AL PROPERTY BACKFILLSEPTIC TANK SIGNATURE SEEP PIT(S)� CESSPOOao OF PERMITTEE _ _ T6A643A 663 7/68 .IT, fie.