HomeMy Public PortalAbout6161 OAK AVE_Sewer__ 1 . 24650 INSERTS
c eceaac., APPLICATION FOR P�RMl*`
COUNTY OF LOS ANGELES SEWER---SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION suILDING s�
ADDRESS +" .2.
JOHN A. LAMBIE, County Engineer 1q,
WILLI A. JENSEN, SuP't of Building LOCALITY
NEAREST
FOR FPPLI ANT TO FILL IN CROSS ST.
L
- EGAL < ✓- ..
DESCRIPTION LOT NO'S �>t'-` P`T� ' _ .�'� .C'�--�z i d OWNER
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
BUILDINGS DISTRICT NO GROUP_ MAP ,PROCESSgD BY
... RK - P6 ,, y
CONTRACTOR I > • �` z .` r
ADDRESS F ���..
CONNECTION DATA
AT N —, f �', DEPTH1 /
y,�? ti .STATE MANHOLE REFERENCE-
REGISTRATION NO, !' - ?--COUNTY
e -
NO. DESCRIP T ION F WOPK FEE -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3.00 TYPE OF CONNECTION — LENGTH.FROM
SEPTIC TANK, SEEPAGE PIT OR Y. CURB 'P,L. M.L.TO P.L,
ITS AND/OR DRAINFIELD _ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD -
EXTN.. CESSPOOL. DRYWELL @ $2.00
HCMSE SEWER CONNECTING TO ,�- t �=:T P.C.NO.
PFciVATE DISPOSAL SYSTEM l0"5 $1.00 _ CO.IMP.NO. %".-2 JOB NO. y�
CONNECT ADDITIONAL BLDG.OR s W
WORK TO HOUSE SEWER @ $1.00
RUNK PERMIT N0. ROAD PERMIT NO �i OU
ALTER, REPAIR OR APANDON HOUSE STATE ENCROACHMENT �
SEWERIOIR DISPOSAL SYSTEM, @ $1.00 PERMIT NO. O
q z l'�..,. s�:t- _---�• }' .INDUSTRIAL U
WASTE APPROVAL
CHARGES
O R'S PERMIT S CONNECTION C14ARGE.FEE
AUTHORIZATION TOTAL FEE ,' 1� REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. -
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE.PUBLIC SEWER. �--^°-- -
SIGNED THIS--.DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR.DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE, LAWS REGULATING ALTER.REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
( HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I.,,AIH HE EGAL,OWNS ,,VF T ABOVE -
DESCRIBED RES IDEN'f�2 40MR. BACKFILL SEPTIC TANKSSIGNATURE Q
-� SEEP.PITS) (] CESSPOOLS (]
OF PER
' yALIDATION ROBERT A. WOOD
' Ci y o, sAs% SUPERVISING MECHANICAL ENGINEER
24650 INSERTS
7CA�szO
7A642D6a APPLICATION FOR PERIVII
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, Countp En ineer
WILLIAM A, JENSEN, $up't o.9.111 ng LOCALITY
NEARESTFOR APPL15 SANT TO FILL. IN CROSS sr. �
LEGAL F
DESCRIPTION LOT NO _` i<"' ..�`" f,r:'A > �!'n - OWNER
BLOCK TRACT --- I +.. MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
DI DISTRICT NO. GRO MAP PRQCESS D BY
BUILDINGS _ ` �. BE PG Fe,
CONTRACTO
4 S <
ADDRESS ;rte ° .�,. , - CONNECTION DATA
CITY `f4.. .`� TEL.NO.
STATE MANHOLE REFERENCE '.. .
REGISTRATION NO. czuNTY
1 �
LOWER
Na DESCRIPTIO, OF WORK FEES
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Cy $3.00 ' TYPE OF CONNECTION-- LENGTH FROM --
SEPTIC TANK, SEEPAGE PIT OR Y. CURB -P.L. Id.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
O
OVERFLW SEEPAGE PIT,DRAINFIELD r- ..
EX N.. CESSPOOL DRYWELL @ $2.00 ,r'7
HOUSE SC14VER CONNECTING TO P.G.N0.
€F a
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP N0. ! �� � JOB NO. �
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0. U
WORK TO HOUSE SEWER @ S1.O0 '.. '�
ALTER,REPAIR OR ABANDON HOUSE I STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. O
INDUSTRIAL U
WASTE APPROVAL a
CHARGES
OvNRR`.Cj, PERMIT I�.2 000 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I � ,� ' REIMBURSEMENT FEE
I HAVE AT THIS. DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS i DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED TYIS DAY OF 19— NEW HOUSE SEWER _
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS.— SEPTIC TANK,SEEP,PI'T(S)
---- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL CI DRYWELL []
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 REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY A,ND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT_j_ AM THE LEGAL 0 TirR r`,k THE ABOVE —
DESCRIBED RESIDE L �R ER _. BACKFILL SEPTIC TANKS L�
SIGNATURE .� p SEEP.PIT(S) ❑ CESSPOOLS El
OF PERMITTEE-
/"'VALIDATION ROBERT A. WOOD
SCK'/ M.0, CASH SUPERVISING MECHANICAL ENGINEER
LAWF