HomeMy Public PortalAbout6220 OAK AVE_Sewer__ CELI08 3 CZ
-6AG42D APPLICATION FOR PER IrT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISP OSAL
BUILDING BUILDING AND SAFETY DIVISION BU17 /0
"' -': �
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST F
FOR APPLICANT TO FILL IN CRO
LEGAL
DESCRIPTION ..
LOT NO OWNER
MAIL.
BLOCK TRAII-T ADDRESSV
NO OF BLDG
SIZE OF LOT 1-W.' ON LOT' TEL..TE � NO.
LSE OF
BUILDINGS DISTRICT NO. 'ROUPMAP PRO CES5EBY
1 D SK
C 0 NTR I A I CT-CAR";
ADDRES
j ONNECTION DATA
C 0, 4�
ITY TEL. TATIO t�r
Ne
--I �P�F F,
yy
TAfE MANHOLE REFERENCE
REGISTRATION NO. COUNT'
-'- --bEsc
N Rtp'riON OF VVORK FEE TY It OF CON' y
NE t LENGTH PROM
VIOL)5 c-SEWER CONNECTING 70 Y M:L.TO
0
P.C.NO.
SEP-IIC TANK.SEEPAGE PIT OR JOB NO.
--FITC-1)N.D'OR GRAINFIELD C
10.00 O.IMP. NO,
Ij')U.S-E r.WERCONNECTINIG TO
TRUNK PERMIT NO. ROAD PERMIT NO.
-PR-1ATE 0�1:PCS�L SYSTEM $3.00
:-1 Ar-'D-1-IONAL BLD6 OR INSTR.NO. I DATE
WORK TO{-{7t) -WER @ 54.00
C'1ER;'',W SE-EPAGE PIT, DRAINIIELD
XYN $5.00
- HWY.OR ST.WIDENI NG z
ALI.ER,RE-A N OR ABA.',"-0-HOUSE
S WER0; D IS P 0 5 A L S,Y S,'E $30
-STAT -
E ENCROACHM ENT—
PER'j t.
INDUSTRIAL
WASTE APPROVAL,,
E
OVIN -c'WS -P mMIT
CONNECTION CHARGE PEE
AUTHORIZATION I To TAL_.--.
FEE
1 HAVE AT THIS DATE A I-',ONTRACT WITH THE HEREIN NAMED CON- PEIMBURSEMENT-FEE
TR.CTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
APPROVALS
TO T E: PU5L_["
H kni ER DAIE INSPECTOR'SSIGNArURE
SIGNED THIS
OWN F RF' E ' E HOU SE -R
OO!^!NERSOAGE'NT— NV, _wv
CONNECT ADDITIONAL.
_BUILDING OR WORK
TAN
HERESY ACS EP7IC KNOWLrUGE THAT I HAVE READ THIS APPLICATION AND,'OR DkK,SEEP,PI"f(S)AINFIELr
A SATE THAT THE ABOVE IG ANO AGREE TO COMPLY _
L
N, TA
WITH
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL [J- DRYWELA-
I H EREBY CERTIFY_Tj.�,�) AM PROPERLY REGIST ERFP AND/OR AL ER,REPAIR,SEWER OR
LICI-NSED AS REQ� D R,;l'LOS ANGLES COUNTY AN ITATE OF SEWAGE DISPOSAL SYSTEM
R'O'
CALIFORNIA OR I At_-111E OF, AN INTEND TO
Df
'j,'7 THE LEGAI 5 C 6N -cc�T UG AND
.L.I.
RESIDE IN VE OESUR[Bro RE TIAL R ERTY. A8.ANDON HOUSE SEWER
OV
0
- C
SIGNATURE
OF PE EE
PERMIT BACKF
ILLSEPTI TANKS
SEEP,P!T 15i cJ C E$SPOOL
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
M.O. CASH
V
CEfrG£i 3-62
76A 42D APPLICATION FOR PER1T
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL �
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B..ILD NG 4 �y
ADDRESS
IfeHN A. LAMBIE, County Engineer Ts �� -- 9F --- ----- ----
WdILLIAM A. JENSEN, Supt of Building LOCALITY
P1En RESP �
FOR APPLICANT TO FILL IN, R3S5 ST
DE£oCR PTI CPA O`�NO if � �- 7 OWNELEGAL
R -
_.,
MAIL.
BLO:K TRACT
/ d ADDRESS
_
NO, OF BLOGS. 0
S;?£ OF' LOT - NOWCN LOT
TEL. NO. -
USE OF
BU:LD NV 5 yJ e TRICT NO. GR LF MAP PR C 3SCD BY
9
BK PG
CONfRZA.70
ADvRF55 I s CONNECTION DATA
CITY TEL. NC� AT14'N
t� N
-- f - - - - - -
y- < '.� STATE MANHOLE REFERENCE ' T
� Dir^
y
�tE.G 7RA7i ON NO. �-'�- �'� LJ COUNTY
NO. ESPTIO v OF_WORK. F —� -. a---- r
yKP£Oi g �C 6N L.ENGI H} M
_. -CRI - _ I t7NCj"}
HOUSE SEWER CONNECTING TO Y S.Gf)i$$ P L. M.L.TO C. _ }
P SI- C SE VLR @ $5 OJ i Y C.NO O
Fr'1IC IRNK.SELPA E PIT ori---- CO.1Fr1P NCJ. !� // JOB IVO.
N(T-ANDiOR-DRAINriFE-D CN $tOOU -_-� �,�...1_ .-
NOUS: rV£R c.ONP�E "iNc TO TRUNK PERMIT NO ROAD PERMIT NO.
RI\ATE r)S J AL SYSTEM §3.030
_- _ ._- r.__
(NNECI AD f !.)NA. BL6r' OR AFF!DA V[T wq vtA' rNSHMENT FHECORD, INSTR,NO.
N)RK 10 HOUSE SEWER ^S.3,00
C RFLO41 SEEPAGE PIT,DRA NFIELD
F.h i N.C_E55PO0- PYWELL MANHOLE $5.00
...-._ ._. HW5' OR ST.WIDENING
Ai TER.REP R ABA ND O*.NOI-1Sr_ I �-
__.
SEWER O SPPO'5 bY5'F 53.00 _ STATE ENCROACHMENT
PERMIT No —' _ ----- ----.- ---
4W ANTE APPROVAL
O 5 I�ERIwIiT 53
ZJ—p r 2,- rt
L 0
'CONNECTION CHARGE FEE
AUTHORIZATION
HAVE. AT THIS DATE A CONTRACT WITH THEE }}EREI NAMED CON- REIMBURSEMENT FEE
Trr^.A FDR TPJ CONNECT THE ABOVE DESCRIBED
EY,I'S 'NG DWELLING ------- - ---------"--T -7 ------
TO NF ,_' .!5Lf_ SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED- TI7Is
OWNER OR '"'•"� NEW.HOUSE SEW ER
-.
0WNENR5 A E�`I ..._—
-' ---_ -- CONNEC ADDfYI CNAL
BUILDING OR WORK
ADDRESS-
SCYTIG TANK,
SEEP.PITT )
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS ADPL CA,!ON ANO/OR 6RAINFlELD
.>,a,I'E THAT 7t'E ABOVE 1S CORRECT AND .AGREE TO COMPLY
AND
WIT ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
S. CESSPOOL DRYWELI
PLU MEtING AND .`.I EIYER3, ❑ � I
HEREBY -ERTII' ,S AT'r I AM PROPERLY REGISTERED RND/OR ALTER REPAIR,SEWER OR }--
LICENSED AS RE I ED LOS ANGLES COUNTY AND `$TATE (OF SEWAGE DISPOSAL.SYSTEM
CALIFORNIA OR T I THE LEGAL O ER OF, ND N,ENU -TO --'— -" -- "----
/ J DiS ONNFGT LUG AND I �j
RFS DE IN, TI OV£ DESCRIBED RE. NTIAL FLOP RTY. ABANDON -_ E55POOL,5
SiOF PL.RE '4 OF PERMiTT SCEP.PLT FEPT�C TANKS ❑I
VALIDATION ROBERT A. WOOD
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CASH SUPERVISING MECHANICAL ENGINEER
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