HomeMy Public PortalAbout6237 OAK AVE_Sewer__ 16AR420 - APPLICATION FOR PERMIT 1
DIVTSI aN OF BUILDING AND SAFETY SEWER--SEWAGE D I S POSA L
Department of County Engineer
County of Las 'tngeles BUILDING
JOHN A. LA"Jl61E, COUNTY ENGINEERI
CASSA'TT D. GRIFFIN, SUPT OF SUtLDINU LOC,ALITY
NEARESFFOR APP14CANT TO FILL IST CROSS ST.
LEGAL
-DESCRIPTION.�LOT NQ�} 4� fP_ � _ 2'� ..._.- OWNER
BLOCK TRACT MAIL SS
NO.OF BLDGS. CITY TEL. N0.
SI7c OF LOT NOW ON LO7
I `OF - -_._ .—....... - -- ---- --
BUILDINGS- DISTRICT NO, GROUP ' MAP
CONTRACTOR
--
ADDRESSCONNECTION DATA
--- ---- -- — --
CITY - TEL DIG. - - - �'�) k' L.fY---'�'. ��b PTH� -
_-- M H A E REFEReNCE _-_UPPER_..
-- — STATE
-REGISTRATION NO. - ❑ COUNTY
No ; DESCRIPTION {)F WORK FEE i --- ------------
hOUSE SEWER CONNECTIN.;1"0 I -- TYPE OF CONNECTION LENGTH FROM
-yl- Y- CURB P.L, M.L. TO P.L. �.
1
PU3LIC SEWER @ c :50 d" -- --.� _..�- ------ ------ -- ----'--
SEPTIC TANK,SEEPAGE PIT OR
_ ! PITS AND/OR DR_AINFIFI,l) r $3_.00 —__ -- ------._--^.- _--..---- -
OVERFLOW SEEPAGE PIT, DRAINFIFLD �I� P. C. NO.
_ 1_xTN.,_CESSPOOL,DRYVeELL,M NHOi E $2,001 CO, IMP. No.F JOB NO.
i
i PPIHOUSE SEWER DISPOSAL
CONN STEM TO t TRUNK PERMIT NO. - ROAD PERMIT NO.
Pr VATS D'SPCSAL SISTEA'1 (2 .}I., L - -_
3'
CONNECT CPLDG OR
WORK TO, HOUSESEWER $ I-;:0 i STATE ENCROA-�4MENT '
PERMIT NO,-,,e_,�`
ALTER,REPAIR OR ABANDON HOUSE -
-�
SEWER OR DISPOSAL S S C, �o-C $I..0 INDUSTRIAL�
-- <---- _`-- -_- ----- - WASTE APPROVAL
CHARGES -
CONNECTION CHARGEFLE
OWNER'S PERMIT S I - ,L 00 - ------ - --- — --- --- --- -----------
--- REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE c+
I -FkVE AT THIS PATE A CON-IRACf WITH THE HEREIN NAMED CON- APPROVALS DATE i NSPECTOR'SSIF.NATURE
7R?,CT06t IC CC Tv*YE r 1Nt .A3O4[ DESCNJ6,.D EXISTING DV,EtL(;vG
TO TliF P.iIBLi SLX.::R, NS';1' HOUSE SEWER -
SIGNED THIS____—__DA.Y GF� --_—i� CONNECT ADDITIONAL
OWNER OR ._BUILDING OR WORK t �
-r-
O! NER AGENT------ -- ---- SEPTIC TANK,SEEP PIT(Sj j_------
ADDR ES,�_____ - - _ .ANDi O'2 DRAiNFi ELD '
iERL,-YACK ;L' EDGF THAT I HAVE READ THIS APPLICATION C£SSPOr:L❑ DRYLc ELL
iLl
A{e? .,:N,TE THE AD.)Vr. 1S CORRECT AND AGREE TO COMPLY
1:TY ALL CO Tv ORDINANCES AND STATE LAW'S REGULATING ALTER,REPAIR,SEWER OR
PLUir:3INc, AXD S F'JF_.'.:S- _SEWAGE DISPOSAL SYSTEM
I k E RCD' CERTIFY'F{ - A. I AM PROPERLY REGISTERED ANDECIR- DISCONNECT PLUG AND
– —.—T_:.�-----------"-------
LICEhSF,J AS REQUIRED BY L.OS ANGELES COUNTY AND STATE O;: - V
CALIFORNIA OR THAT 1 AM I'h LEGAL OWNER- OF THE ABOVE ABANDON HOUSE SEWER '. �
CESCPIPED F'?. I 'P1'1'idll PROPERTY. BACKFILL SEPTIC TANKS L_ --- ----
S1 GIN ATURE _ _SEEP PITS)_J CESSPOOLS u I– –_-- ----.-----i-� .
OF PERMITTEE __ - _ `� �jr-'7,r'
JOHN A, L.AMBIE,COUNTY ENGINEER `ily�LT_D iTION � ROBERT A. WOOD. CFIJEF PLBC. INSPECTOR
CASH -
E8bB 11_g7 1
C _ _ APPLICATION FOR PERMIT'
�e�e 1 •' APPLICATION
_ COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND`3AF1;TY DIVISION BUILDING
JOHN A. LAMBIE, Couatg Ea Builaoor ADDRESS _
CASSATT D. GRIFFIN, Sup t of ding
LOCALITY
FOR APPCA.NT TO FIL IN CRONEASEST
S Sr,
LEGAL
DESCRIPTION LDT'149:-' -^"`"'�ffi-�`' L.-f.:.:. -{w.,;.• _OWN.ER
BLOCK TRACT MAIL
4 ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS —` _ _ _ _Ry DISTRICT NO. � 16ROUP � MAP
CONTRACTOR ."-
ADDRESS CONNECTION DATA
CITY TEL,1\10, "gnIEPTH
[� STATE MANHOLE REFERENCE UPPER-
REGISTRATION N0. -- ❑ COUNTY LOWER
No. DESCRIPTION Of: WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $S: TYPE OF CONNECTION LENGTH FROM,
SEPTIC TANK,SEEPAGE PIT OR Y CURB A.L. M,L.TO P.L.
PITS AND/OR.DRAINFIEL.D @ $3.00
OVERFLOW SEEPAGE PIT,DRAINF1ELD A—
EXTN.,.CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING.TO u
PRIVATE DISPOSAL SYSTEM (a? $1.00 CO. IMp;NO. �1__ ,z- - P.C.No,
,:/ JOB NO_
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 i TRUNK PERMIT NO. ROAD PERMIT NO./
ALTER,REPAIR OR ABANDON HOUSE I
SEWER OR DISPOSAL SYSTEM @ $1.00 I STATE ENCROACHMENT
PERMIT NO. _
¢ _ INDUSTRIAL.
T - - WASTE APPROVAL
CHARGES
OWNER'S PERiVLiT S CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE `> c REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS A� DATE ,INSPECTOR-SSIGNATURE
TO THE PUBLIC SEWER.,
SIGNED THIS —_DAY of---. 19— NEW HOUSE SEWER
OWNER. OR CONNECT ADDITIONAL
OWNERS AGENT -_� _BUILDING OR WORK
SEPTIC TANK,SEEP,PIS)
ADDRESS T_ AND/OR DR INFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL-[I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER REPAIR SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/QR —SEWAGE DISPOSAL SYSTEM.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATF OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS ❑ I
SIGNATURE
SEEP. PIT(S) D CESSPOOLS
- ti ,
OF PERM ITTEE-�-, — �"" /4 f`
VALIDATION ROBERT A. WOOD
CK.. M.0. CASH SUPERVISING MECHANICAL ENGINEER