HomeMy Public PortalAbout6218 OAK AVE_Sewer__ J
SA642D`'? APPLICATION FOR PERMIT
OF ANGELES
DEPARTMENT OF COUNTY ENGINEER
NEid SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION FUILLHNC f j
JC)Ffbi A. LAMB%E, County Engineer ADDRESS
WILLIAM A. J,ENSEN, Supt of Building
LOCAL ITY
NEAREST
FOR APPLICANT TO FILL IN C ROSS 5y.
DESCRIPTION LOT NO. .' OWNER "
—j
MAIL
BLOCK 7'RAC7 ADDRESS ✓ _�%�_�i-_ �✓�_�.�s:� �y` �r
NO, OF8LDGs.
SFZE f+G LOT AJOW ON LOT CITY 'd'E;. NO.
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eu ILDINGS •! DISTRICT NO_ GROUP MAP PROCESSED BY
ar
CONfRACTO P.
ADDRESSy CONNECTION DATA
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CITY "">"- ,+'' OSTFAPY'FON �:---- DEPTH
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REGISTRATION NO, �✓ �, II —_—� S7A-'s MANHaLE REFERENCE
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NO DESCRIPTION OF WOfRK FE _ — £3]!N ^-- - i NC rt E _ _.
';h"PE OP.G F''CT14N F { R M
�+ T ri0U5 F,'SFV4 Ffc CO MN CCTI€.IG iO - -'_f `. (,C[m6 --( F L.—_ _M L TO P.I,. _
USLIC SEWER @ $5.00 - -- -"
SEiTIc.;YAN K:SECPA.GE:"I"C iJR - � ? P
P,TS AND/OR DRAINFIELD CO,IMP. NO. � - d JOB NO.
OU SIi EW R'�ON N EC, i N G T i
Y'RUNK PERMIT NO ROAD PERMIT NO f
PRIMATE D S OSAL SYST,_M `@ $3.00 _ P
_ .- - _. -.. _ i.3
LI NE ADDI'S'7 ONA BLD )R -_ t_.._ _ _ __ _
AF�iGAY T WAWER €0.<E ME'e ! RE('ORD.7NSYR NO. pDATEv' 0
We t K' O HOUSE LASE SEWER 53.00
CVERFI- .W SEEPAGE PIT,DRAINPIELD---- -- -__--- -_._._.
----_-.-I FXTN.,f ESSP OOL DRYW ELL,MA 2i OLE @ $:5,00
AL.ER ERREPAIR OR AHA ND
-O 4}'"U5_E: }IWY. OR ST.WIDENING'
.
_ -
SEWER OR GfSPO AL SYSTEM �((' 53.06 � ! -_..-. STA Y'E.- ENCROACHMENT
PFRMIT NO.
INDgSTRIAL
WA,%TE APPROVAL
OWNEWSPERMIT 2 00 e cgR Eti
CONNECTION C'HARC-..FEF
AUTHORIZATION TOTAL Flat;
HAVE AT THIS `SATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE'
TRACTOR '7'O COIJNECT THE ABOVE DESCRIBED EXISTING DWELLING -. .-.- - _- ._____.—. _.._r..____ _____-_-_..
TO THE PUB IC SEWER. _ 7S i DATE I INSPECTOR'S SIGNATURE
- APPROVALS
SIGNED THIS_. DAY OF__--_ -_—'g--
O W N I-R OR
NCW HOUSE SEWER
E"-
- - -
CONNECT ADDITIONAL I
ADDRESS- BiI!LDING OR WORK
_ ..._ _. SEPTI TANK.:SEEP.PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIC.ATtON AND/OR DRAP'NFIELD j
AEN .DTAYE THAT .HE ABOVE :S CORR'7,.T AND. AGREE TO COMPLY
Lti IT
AL.L CO LINTY ORD INANCEFS AND STATE LAWS REG-ULAT'ING '.
PLUMBING AND EWERS. CESSPOOL 01 DRYWELL CJ
I 4.Rrey CERTIFY TdjA°f'_iJ AM PROPERLY REGISTERED AND,'`OR ALTER.REPAIR EWER OR -_�� -- I -- - -- --_--�
LICENSED AS REQU:. BY,'LOS A14GL-ES COUNTY ANgf STATE OF SEWAGE DISPOSAL SYSTEM '
A^_IF O.R IV IA OR a; I ANpf"TURF LEGAL L'R.Q AN - INTEND 70 DISCONNF PLUG AND
E2 E.SI DE IN, TF OVE,HIES'CRI BED R SI Til iA PR ERT-. ABANDON HOUSE EWER
SIGNATURE +✓"�
HA.;KFl L> SE PTf., TANKS -
OF PERM'T SEEP.PIS IS) El CESSPOOLS Q�
VALIDATION ROBERT A. WOOD
>'ctc.,' at.D. CASH SUPERVISING SUPERVISING MECHANICAL ENGINEER.
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C-2 A08 3�62 I
76AE542D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES il
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
7s
FAE
1011-N A. LAMBIE, County Engineer ..... n-z 4
WILLIAM A. JENSEM Supt of Building
LOCALITY "A
CROSS ST.
FOR APPLICANT TO SILL IN
I
LEGAL.
DESCRIPT!ON Lo-,
OWNER
MAIL
EIL 3-'K TRACT
ADDRFSS v
0. OF BLD'S.
CITY r
OF N ow ON LOT TEL.
USE OF
W L
DISTRICT N0 GROUZ-] MAI' PROCESSED BY
CO TRACTOF
IS, P.
-4
ADDRESS CONNECTION DATA h.
74c,
CITY 4- E;'TH
S % UPPE�
A�- MAP414OLE REFERENCE
REGI., NO. T R
`0UNTY
C ------
LE�N-G -;�Hs
DV I'H
2�n- (54� NiVORY TY�E OF CONVI�CT
SES 5r,,ER7CQNNECTING TO r -Y. -c1jRB- "E"i M .70 PA
PUBLIas"FR ss.aa
0
S_PTAC TAWKI SEEFAGEFITOR ------ P.C.NO
PITS AND,'OR DRAINFIELD @ S70,00 CO.IMP,NO. JOB NO.
CONNECT;-NG To +
TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3,00 0
AFFIDAV AIVEa E,,E.fNt RECORD.INSTP,NO. DATE
WORK TO HOUSE SEWER
OL cRFL CW SiEEPAiETE PIT,ORAINFIELD
FXTN.,CE:53$PODL,DRYWFLL.MANsIOLF @ $E 00 L
- - - -A8Z - -0 --- I
ALI`EP.REPAIR OR NOON H LISE HWY.OR ST.WIDENING
@ $i.00 1 - - --i' -
M N'T
--- STATE FNCR&.ACH
PERMIT NO,
—4;;
tNDUSTR;AL
WAIT.E,Al'1OVAL ir
OV4NRMIT CHARGES
F.ws---I-
CONNECTION CHARGE:FiE
AUTHORIZATION I TOTAL FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBUR'EMENT F
TRACTOR
To CONNECT THE ABOVE DESCRIBED EXIST'Nr, OWELL.[N(C
1 HE _L(C SEWER
APPROV
PALS DATE IN$PECTOR'SSIGNIATURE
SIGNEDlHiS
C �
WNERR ZNT
OR NEW HOUSE SEWER
C%4 ......
NES AG _-_
N
CONNECT ADDITIO
ADDRESS BUILDING OR WORK
F
�T7PTiC:TA?4,. -PP�T(S
I H E HE.UY ACKNOWLEDGE rHAT, I HAV[. RKAD !HI5; APPLI:ATION AN 'IJORAL NI`i��LU
AND STAR'; THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
�V!_TH All. COUNTY ORDINANCES AND STArE LAWS RVIGULATiNG
F7 UMH!
NG AND SEWE Ps. cE"p0(,L L, L)RYWFLL
E p C T 1)AM PROPERLY RECISTrRXD AND/OR ALTER,REPAIR,SEWER-R
-IF'T"' -)eEFOSAL SYSrOEM
_R E:BY r�'E
-CE NS�- A. 7. ED 5Y,-,-O5 ANGLES CO1JN1Y,ANr0 STATE OF SEWAGE
11R U A OR A N
CALIFC N 'A I AM,,"HE: IEG ly" DISCONNECT PLUG AND
N�R 6 INTEND 'TO
RESIDE I,,, TH ZIT-AXI: PRQ�ERTY. REEP,PIT(HOUSESSIGNATURE
OF PERMIT ACKFILL SEPTIC TANKS IS) CESSPOOLS
VALIDATION ROBERT A. WOOD
CK, M.Q. SUPERVISING MECHANICAL ENGINEER