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Home My Public Portal About6126 OAK AVE_Sewer__ DEP"MENT OF COmvKY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING 0 As A WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS (2, 12C FOR APPLICANT TO pp FILL IN I—NEA LITY BUILDIN ! NEAREST ADDRESS $I �►+� 6� GROSS ST. LOCALITY E��m��i' � TRICT N0. SERIAL N0. PERMIT N0. c CROSS 8T. fl�'ei11l av � A -' D C-'l- J t_IIVEABY Roady for Inspoction DATEISSUED_WNERMAIL ADDRESS • Im® =0 OCC BK MAPPG CITY TEL.NO. At rm= I -r-_- - -2.0 CONTRACTOR ftar8® ZuoUerg CO.IMP.NO. ADORES N. 0014M V96A AVS* JOB NOi CITY TELAO. AftM67/a2 TRUNK PERMIT NO. w STATE REGISTRATION NO. COUNTY ROAD PERMIT NO. -,I-- LEGAL �' }j� d / f�-�(•' �1'ls f(I STATE ENCROACHMENT DESCRIP O0 ,,LO'Fff +rb( F PERMIT NO. � BLOCK 6/TR61CT �� L INDUSWASTE TRIAL SIZE OF LOT-e ""�� N0.OF BLOT CHARGES NOW ON LOT -11-100 USE W8111M & Waw kjC=08 CONNECTROV BE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 5.50 C, RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLOB.OR Q EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO- I DATE I BY _SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION2, I �?� DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 H�fOt��EFERENCE UP.PEIL 1 TYP F C C LENGTH FROM OWNERS PERMIT $ 1 00 cuss 'EF—Z' M.L.TO P.L. Z� AUTHORIZATION I TOTAL FEE nr I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE P BLIC SEWE �'-f1�� I9.—li NEW HOUSE SEWER ,�aQ SIGNED THIS_. . ._..DAY OF.... .C:.. s 1- y OWNER OR ,l _ I CONNECT ADDITIONAL OWNERS AGENT..... . j... i/ 'f " BUILDING OR WORK --_,- / _^ SEPTIC TANK,SEEP.PIT(S) ADDRESS. Rr-l• ��...........•-.....----,.�• AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS GELES COUNTY AND STATE OF CALIFORNIA OR THAT I AWTHE LEGAL OWN- ABANDON HOUSE SEWER ER OF THE ABOVE CRIBED RES. IPE)W AL PROfPERTY. / BACKFILL SEPTIC TANKS[] SEEP.PIT(S)[] CESSPOOLS S a,p £ - 4— SIGNAT OF f CC + +PER ._.d.._.._... : 76A642A 663 7153 C tl� 3-E4 76A6420 APPLICATION FOR PERMIT 76A54 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FA INS JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN. Supt of BuildingLITY -14EST FOR APPLICANT TO FILL IN CROSS $T. ___YT---_---- zw DESCRIPTION i LOT NO --�1 k. -1 T { OWNER MAIL BLOCK _ E TRACy.�' '� �+Cr— ADORES/ yy / �g�.+� NO. OF BLDG$, SIZE OF LOT 4/ ! Cdd_ NOW ON LOT CITY TEL, NO. DISTRICT NO. GROUPBK MAP} PG PROCESSED BY BUILDINGS /�"'✓��` CONTRACTOR ADDRESS 9 / s CONNECTION DATA CITY L. NO, STATION DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION NO. COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER S5.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR r-- }• CO.IMP.NO. PCL ITS AND/OR DRAINFIELD $10.-00—}I- JOS NO. rr HOUSE SEWER CONNECTING TO ! — TRUNK PERMIT NO. ROAD PERMIT NO. (�,J PRIVATE DISPOSAL SYSTEM $3.00 ' CONNECT ADDITIONAL BLDG.OR v AFPIDAVIT Welyt[ [AS[M[HT RECORD.INSTR.NO, DATEce WORK TO HOUSE SEWER $3.00 ✓ I OVERFLOW SEEPAGE PIT DRAINFIELD -rte-+�' I"' EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00_ / ',WI ,_/ _ dfr U ALTER,REPAIR OR ABANDON HOUSE T7 pN L. CL SEWER OR DISPOSAL SYSTEM 53.00 — - to STATE ENCROACHMENT Lo I—. _.--_--- -�--� PERMIT NO. Z ----- INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $1 2 ao — 1 `-- CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE w TRACTOR TO CONNSNG ECT THE ABOVE DESCRIBED EXISTING DWELLIAPPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF —19— OWNER 9_OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL . _ •' B U I L D I N G�3iiWAb�R+f•* 7�. -? ' ADDRESS__. --- SEPTIC TANK,SEEP,PITS) f - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - -- WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LTC ENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CA-IFORN IA OR THAT I AM THF_ LEGAL OWNER OF, AND INTEND TO DISCONNECTPLUG AND REST DE IN, THE ABOVE DESCRIBED, RESIDENTIAL PROPERTY ABANDON HOUSESEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE - I )f -- SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER .� k