HomeMy Public PortalAbout6239 OAK AVE_Sewer__ 70A0420
APPLICATION FOR PERMIT
'BUILDING AND SAFETY SEWER--SEWAGE D I SPOSA L
� '
11y-IUIP21nt of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ,ADDRESS
CASSATT D.GRIFFIN, SUP'T Or BUILDING LOCALITY
-NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
DESCRIPTION LEGAL 4--
D
-C OWNER
MAIL
BLOCK TRACT j ADDRESS
O, OF iL!,G$.
NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP
---. ---, '-. I PG
CONTRACTOR
ADDRESS CONMCTION DATA
CITY TEL NO.
M N LE REFERENCE UPPER
-STATE —------
REGISTRATION NO. COUNTY
NO. i DESCRIPTION OF WORK FEE
TYPE Or CONNECTION LENGTH FROM
HOUSE SEWFR,CONNECTINGIO
CURB P:L. LTH P.L.
PUBLIC SEWER
SEPTIC-.ANK,SEEPAGE PIT ..R
PITS AMD OP DRAINFIELD (4, $3.00
OVER LOW SEEPAGE PIT, DRAINFIELD i P. C. N0.
E ITIN C
:,CE SSPOL-DR'(WE)L,MA'NH OL F ei S 2.010 CO, NO, JOE H0.
i0USE 5ElS ER CONNr.CTING TO
PPI'ATE DISPOSAL SYSTEM !'r 1,C 2
TRUNK PERMIT NO. ROAD PERMIT NO
CONNECT ADDIT!ONAL BLDG,OR STATE ENCROACHMENT
V1 ORK TO OU-E SEWER $-1.00. PERMIT NO.
ALTER, REPAIR OR ABANDON HOUSE INDUSTRIAL
SEW5R OR DISPOSE L SYSTEM 0 $1,c'�
—---------- WASTE APPROVAL
CHARGES
- ---------
CONNECTION CHARGE FEE
OWNER'S PERMIT 00
REIMBUPSEM IT FE'
EN
AUTHORATION TOTAL FEE -':il &c,-
I HAVE AT THIS DATE A CONTRACT 11TH THE HEREIN NA.-ED Cll• APPROVALS DATE jINSPECIOR'SSIGNATURE
TRACTOR TO CONNEi:T THE ABOVE DESCRIBED_EXISTINC DWELLINI-
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS---DAY Or,---19-.---, 011N E
'T ADDITIONAL
Ci
OWNER OR SUILD;Ncl OR WARN
FOWNERS AGENT-.—,-.--------—_ SEPTIC TANK,SIEP PITC"�
ADDRESS- DRAINFiELD
1HERN
BY ACKO-KLEDGE THAT I HAVE READ THIS APPLICATION
AND STA-ETH AT THE A�3OVE 15 CORRECT COMPLY
AND AGREE TO CESSPOOL L, DRYWELL
W;TH ALI. CGUN1Y ORDINANCES AND STATE LAWS REGULATING �LTCR,REPAIR,SEWER OR
PLUMBING AND SFVrERS.
SE'NAGE DISPOSAL SYSTEM
1 'r FP CF FY THAT I AM PROPERLY REGISTERE:G ND/'OR
LICE�SED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CAI."'F'ORNiA 1351 VF"'! 1 ANI THE -L OWNER OF THE ABOVE Ab.-ANUON HOUSE SEWER A
DES"'RfEED RESIDENT1AL PROPERT.. 1ACKF LL SEPTIC TANKS
SEE" r ms) LI CESSPOOLS,�3
SIGNATURE
OF PERMITTEE
JOHN A. LAMIBIE, COUNTY EI,4GINEER " ,VALIDATION ROBERI-A.woor,,!ci--,if-F PLBG, INSPECTOR -
-18 - JAMI
0 0 A 5.00
CEL'082! APPLICATION FOR PERMIT
,COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup t of Building _LOCALITY
NEAREST
FOR APKJCANT TO FILL IN CROSS ST.
[REGISTRATION
GAL t:. '. f, -
RIPTION LO 0 k `.1, OWNER
K TRACT ,+'. MAIL
ADDRESS
NO.OF BLDGS.
OF LOT NOW ON LOT CITY TEL.NO.
OF
DINGS DISTRI N0. GROUP ' MAP
RACTOR 1 P-tw PG`RESS ; CONNECTION DATA
TEL,NO. 14 IONi � DEPTH zitSTATE MANHOLE REFERENCE UPPER_
NO' - H COUNTY - LOWER
N
O. DESCWTIOIq OF WORK FEe
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM s
PJTS AND/OR DRAINFIELD r]p $3.00 Y. CURB P.L. -M.L.TO P.L,
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWEJ L,MANHOLE @ $2,00
HOUSE SEWER CONNECTING TO P.C. NO.
_PRIVATE D;SPOSAL SYSTEM_ C $1.00 CO.IMP.N0. ✓.J ,�° ✓ _ JOB NO.
CONNECT ADDITIONAL BLDG.OR r
WORK_'I'0 HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.Z a -}'•
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM (L@ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIA4'; ,�` ' —
° WASTE APPI1 6VIO -'
OWNE&r3 CHARGES
S PERMIT $ -` !J tin CONNECTION CHARGE FEE
THORIZATION' TOTAL FEE
REIMBURSEMENT FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR'S SIGNATURE
CTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
HE PUBLIC SEWER. — --{
SIGNED THIS. _DAY OF .I g—_ NEW HOUSE SEWER
OWNER. OR - - CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.PITS)
ADDRESS— _. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE iS CORRECT AND AGREE TO COMPLY CESSPOOL[I 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/OR SEWAGE DISPOSAL SYSTEM
�d_
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND S'iATE OF DISCONNECT PLUG AND I
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER _
DESCRIBED RESIDENTIAL PROPERTY, BACKFILLSEPTI CTAN KS❑
SIGNATURE SEEP. PIT(S) E) CESSPOOLS ED
OF PERMITTEE_.„:
VALIDATI®N ROBERT A. WOOD
C.K.' N.0. CASH SUPERVISING MECHANICAL ENGINEER
0 9 JAW
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