HomeMy Public PortalAbout6204 OAK AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, Suw*r of BUILDING ADDRESS
FOR APPLICANT TO FILL IN LocALlry
BUILDING v REAREST
ADDRESS 'K % CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTT -------- —
CROSS S7 RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP
ADDRESS -'v •<. BK PG
CITY - TEL.NO. f
CONTRACTOR +f CHARGES REIMBURSEMENT FEE
ADDRESS I:EQLIR€D -.,_-
-- -- ----- --- NOT REQUIRED
CITYxy TEL NO- JOB NO. CONNECTIOM'GHARGE FEE
STATE
REGISTRATION NO. GsiiNT7 CO.IMP. N0.
LEGAL - ItFCEIPT NO. DATE I BY
DESCRIPTION LOT N0.
— — ——---
Ar
BLOCK TRACT ., , ; WAIVER FOR RECORDING
SIZE OF LOT NO.OF BLDGS. RECEIPT N0. I DATE (BY- -
NOW ON LOT
USE OF
BUILDINGS e`
NO.I DESCRIPTION OF WORK FEE TRUNK PERMIT N0.
JHOUSE SEWER CONNECTING TO ROAD PERMIT NO.
UBLIC SEWER @ S 3.50OUSE SEWER CONNECTING TO STATE ENCROACHMENT
PERMIT NO._
DISPOSAL SYSTEM 1.06 —�
CONNECT ADDITIONAL BLDG.OR ( INDUSTRIAL
WORK TO HOUSE SEWER IAO WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER --—
ND/OR DISPOSAL SYSTEM 1.00STATION DEPTH
1 SEPTIC TANK SEEPAGE PIT OR ---- --
TS AND/OR DRAIN_FIELD 2A0
—�PII MANHOLE REFERENCE
- _
CESSPOOL—ORYWELL ���R _ � LOWER
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM _-
++ Y. CURB P.L. M.L.TO P.L.
OWNERS I PERMIT $ I 1 00 - —
AUTHORIZATION I TOTAL FEE
CONTRACTOT
IR DATE CONTRACTED WITH THE D CONNECT THE ABOVE DESCRIBED I NAMED
EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER —
SIGNED THIS_._.-------------DAY OF..-_------._----.............._--------19------ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
f..
OWNERS AGENT BUILDING OR WORK^ -
SEPTIC TANK,SEEP.PIT(S)
ADDRESS ----- ------------------- - - ... - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGUSE AND _
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)0 CESSPOOLS
OF PERMITTEE---- -_.........
76A642,D 60 12/5-2
3 a E.S669 1t•55 E
a APPLICATION FOR PERMIT 1
4 o .
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING:
JOHN A. 1_AMBIE, COUNTY ENGINEER -ADDRESS --
CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST '
FOR APPLICANT TO FILL IN GRass sr. - ----------
LEGAL
DESCRIPTION - L07 NO. _ OWNER�.��,.
_ _
BLOCK, T MAIL
TRACT
`
-- MSS
NO. OF BLDGS. '
SIZE OF LOT f -NOW ON LOl-
'T CITY TEL. N0.
USE OF � } ay/ - - `
:BUILDINGS „�i/ J:� DISTRICT NO. CROUP MAP
BK PG
_,;
CONTRACTOR BK
� ..<
ADDREss CONNECTION DATA
CITY TEL NO, DEPTH
_ --_ --I,gANHOLE REFFRENCE.c�-----
STATE
REGISTRATION NO. ❑ COUNTY r
NO. 1 DESCRIPTION Or WORK FEE
- --- -- - - --`-- TYPE OF CONNECTION LENGTH FROM
i HOUSE SEWER CONNECTING TOY.' Y. CURB P L. ht L, TO P L. -
PUBLIC SEWER --- -
fad ..:._-. P. --
SEPTIC TANK SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD $3.00=1
OVERFLOW SEEPAGE PIT DRAINFIELD - P C N0.
i EXTN ,6ESSPOOL,DRYW ELL,MANHOL£ (�L CO. IMP NO. 10B NO. -.
_ .—
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM _ (al $i_.m _ _ DRUNK PERMIT N0. .ROAD PER_MITNO.
CONNECT ADDITIONAL BLDG.ORSTATE
HOL,SE SEWER (o n I STATE ENCROACHMENT
WORK TO
-==------ - ----- - __ $LOC' PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE - -� �- INDUSTRIAL
-- -- -- --�` ---
! SEWER OR DISPOSAL SYSTEM (z $1.00 WASTE INDUAPPROSTRIAL
-
CHARGES
CONNECTION CHARGE FEE
OWNER'S -PERMIT _ S 1 00 - ---
REIMBURSE.M.ENNT FEE
AUTHORIZATION TOTAL FEE
I AVE ATOHIS DATE A CONTRACT WITH THE HEREIN NAMED CON.S+ APPROVALS
DATE INSPECTOR SSIvNATUR£
CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS -DAY OF 19 CONNECT ADDITIONAL --� -- - -
OWNER OR BUILDING OR WORK
OWNERS AGENT _ - -'✓� -
_-- - SEPTIC TANK,SEEP.,PIT(S)
ADDRESS AND/OR DRAINFIELD__-_-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O CRY 5'ELL E]
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
1 HE.R£8'f 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 THTC, 1 A),! THE LEGAL 0 ER, F THE ABOVE ---- ------ — - - ----_
DES RESIDE A �PPER7'Y ,�,. ` BACKFILL SEPTIC TANKS[]
f
SIGNATURE } SEEP. PIT(S) Q CESSPOOLS C
OF PE-RMITTE ` -
IOHN A. LAMBIE.COUNTY ENGINEER VALIDATION,�'� ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
6K. N.0. /CASH;I
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