HomeMy Public PortalAbout5917 OAK AVE_Sewer__ 76A 642.D APPLICATION FOR PERMIT
78A 8
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 3BY
JOHN A LAMBIE COUNTY ENGINEER ADDRESSCOLEMAN W JENKINS SUP T OF BUILDINGLOCALITY
OMMOMF R PPL C NT TO FILL IN NEAREST
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LEQDESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT ADOR SS IA ndo .1 kLhNO OF BLDGS t�SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF DISTRICT NO GROUP CKLASS MAP PROCESSBUILDING
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CONTRACT S �Y v
ADDR B CONNECTION DATA
CIT I Y Q.*,�) TEL NO VA _ STATION , DEPTH /
STATE \ ` LIC MANHOLE REFERENCE
LICENSE NO GLABB G LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENG FROM
HOUSE SEWER CONNECTING TO Y CURB PL M L T PL
PUBLIC SEWER a $500
C NO
SEPTIC TANK SEEPAGE PIT OR
J
PITS AND/OR DRAINFIELD ® $1000 CO IMP NO OB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM $300 0
CONNECT ADDITIONAL BLDG OR AFFIDAVIT VAIY[ T RE
� [AIRY[RCORD INSTR NO DATE V
WORK TO HOUSE SEWER $
I 00T
OVERFLOW SEEPAGE PIT DRAINFIELD D[
E%TN CESSPOOL DRYWELL MANHOLE O $300 HWYOR ST WIDENING 0
Ian ABANDON HOUSE V
SEWER YrY1B�L SYSTEM ® $300 STATE ENCROACHMENT W
PERMIT NO d
INDUSTRIAL _ Z
WASTE APPROVAL z
OWNER S PERMIT i 00 CHARGEE
AUTHORIZATION TOTAL FEE F_�?/}v CONNECTION CHARSK FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TOATHERTo CONNECT PU13LIIC SEWER THE ABOVE DESCRIBED 1312 1102 APPROVALS
.ATB INSPECTOR 8 SIGNATURE
SIGNED THIS DAY OF _19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
1 Y ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK BEEP PIT(8)
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY C TIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS QUIRE. BY LOB ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA O MAT 1 AM THE LEGAL OW NE OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN TH ABOVE DESCRIBED RESIDlNTI PROP TY ABANDON HOUSE SEWER
SIGNATURE
OF PERMfTTEE BACKFILL SEPTIC TANKS ❑
BEEP PIT(S) ❑ CESSPOOLS
VALIDATION JACK R ALLEN
M o CASH SUPERVISING MECHANICAL ENGINEER
t All 1 5 P 09 jUL20 1 3 o 600—
78A8420 '
6 8t B 888 12 94 APPLICATION FOR PERMIT _1
DrMION OF BU=1NG AND SAFETY SEWER-SEWAGE DISPOSAL
Deposimeaf of Coaatp Eaglaeer
county of 1.08 Angeles BUILDING
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN Sur T on BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO ;346 OWNER
BLOCK TRACT MAIL
ADDRESS
S1IE OF LOT �+' NOW ON`ODGS
rYllPftr TEL
USE OF
BUILDINGS DISTRICT NO GROUPNAP
BK P6
CONTRACTOR .5 1 `� 2
ADDRESS CONNECTION DATA
CITY TEL NO STATION 0 4- 1519 DEPTH
STATE MANHOLE REFERENCE �//' l
REGISTRATION NO J �� � /n� COUNTY OU6PiR+ - i1/a! LOWER_
TYPE O NECTION LENGTH FROM f
NO DESCRIPTION OF WORK FEE Y URB P L M L TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER S 930
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO IMP NO r JOB NO
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNERS pERMT s 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVETTO CON ECS THE ABOVE DESCRIBED EXHIS DATE CONTRACTED WITH THE ISTING DWELLING IN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER [ t
SIGNED THIS TI DAY OF i9�� 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 HAV9 READ THIS APP ATION CESSPOOL[3DRYWELL
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 REGIST ED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNT ND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWN OF THE ABOVE
DESCRIBED RESIDENTIAL P OPERTY BACKFILL BE C TANKS❑ Q�
SEEP PITS CESSPOOLS u0
SIGNATURE
OF PERMITTE
WILLIAM J FOX Coo ri maiNESR ATION
BY BY
DEPUTY Cp 7�! 2 4 0 u'►47/1'
APR 12 4 4.5 OPEPINY
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By 8Y 1'
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