HomeMy Public PortalAbout6241 OAK AVE_Sewer__ 3 E-663 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A, LAMBIE, COUP4TY ENGINEER ADDRESS
CASSATT 1). GRIFFIN, -SUP'T OF BUILDING LOCALITY
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APPLICANT TO FILL IN ROSS ST.
LEGAL
DESCRIPTION LOT OWNER
MAIL
BLOCK TRACT S ADDRESS
SEZE_RF LOT NOW ON LOT CITY TEL. N 0.
USE OF
DISTRICT NO, h GROUP i. AP
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BUILLifIGS
CONTRACTOR
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ADDRESS CONNECTION DATA----
A, y
CITY TEL NO.
0E REFEREGE UPPER
R-
STAFE 1�—1
REGISTRATION NO. COUNTY
NO DESCRIPTION OF'NORK FEE
TYPE OF CONNECTION LENGTH FROM
HO St SEINER CONNECT-ING TO ------
Y- CURB F.L. M.L.TO P.L.
PUBLIC SEWER
4-
SEPTIC TANK,SEEPAGE PIT UR
j PITS AND-IOR DRAINFIELD S'"".00
OVERFLOW SEEPAGE IT,DRAINFiELD P. C. NO.
2.00 I CO. IMP. N 0. iFjOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM !.0" RUNK PERMIT NO. ROAP PERMIT NO,'
CONNLCT ADDI'fICNAL BLDG.OR STATE ENCROA-LIME-NT'
%YORK TO HOUSE SE:wE-R 0 "(o' � 'j ,
PERM IT NO.% .P
INDUSTRIAL
ALTER,REPAIR OR AFANDON HOUSE
-SEW-ER OR_',)iSPO-SA-L-�YSTEM---- --i?k WASTE APPROVAL
CHARGES
------- CONNECTION CHARGE FEE
OWNER'S PERMIT 00
AUTHORIZATION TOTAL FEE REIMBURSEMENTFEE
oz" APPROVALS DATE 1INSPCCTOR SSIGNATURE
I HAVE AT THIS DATE A CONTRA: Y WITH THE HrLKIN NAMED CON-
TRACIOR TO CONNECT THE ABOVE D-ESCRi-`I:P EXISTING DNELLING
TO THE PUBLIC SE�',iER. NEW HOUSE SEWER
SIGNED THIS--DAY
CONNECT ADDIT IONAL i.
OWNER OR FUILDING OR WORK
ONNFRS AGENT-------_. SEPTIC TANK,SEEP,PiTfS) II
ANDYOR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I kAVE READ rHIS APPLICATION Lj DRYWELL
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CESSP30L
AND STATE THAT fHE ABOVE IS CORRFrT AND AGREEE TO COMPLY
WITH ALL COUNTY 0 R DIN LACES AND STATE LAV'- RECULATING ALTER. REPAIR,SEWER OR L.
S "S
L A'N
N
PLUMBING AND SEWERS.
SEWAGE
DISPOSAL SYSTEM
R y A
� R H T I AM
I"Y CERTIFY THAT I AM PROPEFILY REGISTERED AND/OR
D R -ED Y ATE OF
LICENSED A S R E Q BRED q I,D BY LOS AN LE COUNTY AND S�- DISCONNECT PLUG AND
- - `I- I
T I MTH
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R A
1" 01.
'HAT 0 ABANDON �IOUSE SEWER
CALIFORNIA OR. I AM THE L.r��,AL 'Y'KNER .1 T. AD VE
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, "S - ''I_ - 'T'
DE-CRiFED RrSI V.{TtAL PROPERTY, BACKFILL SEPTIC TANKSILI
SEEP. PiTfS) I
SIGMA NAT U 2 E CESSPOOLS[I
OF
10-i=re[A. 1-AAMBIE, Cru,, z ENC T: VALIDATION fROIBERT A,WOOD, CPNEF PLBG. INSPECTOR
cX, M. 0. CASH
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78864211
APPLICATIONCE EOfI'Y I,57 FOR P E P M 1 T 1
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARMIENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
IOHN A. LAMBIE, County E Yaees ADDRESS��
CASSATT D. GRIFFIN, Supt .1 ,ding
_ LOCALITY
NEAREST
FOR APPIJQANT TO,,FILL INceoss,sz._—� _—;—
LEGAL — --
DESCRIPTION LOT NO ° '°, x; a,.. nom_ �N:,� L OWNER
BLOCK TRACT MAIL.
ADDRESS
NO.OF BLDG$.
SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE GE
BUILDINGS DISTRICT NO. GROUP MAP
CONTRACTOR { —BK P6
ADDRESS CONNECTION DATA
CITY TEL.NO. ql y °,'r ,'` DEPTH
STATE. N} LE REF�RENCEa UPPER
_ REGISTRATION NO. [] COUNTY _ LOWER
NO. _DESCRIPTION OF WORK FEE
ROUSE SEWER CONNECTING TO 4c'
PUBLIC SEWER @ $3• TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR 1 Y. CURS P.L. M.L.TO P.L.
PITS AND/OR DPAGE PIT., G�? $3,OD_I
OVERFLOW SEEPAGE PIT,DRAiNFiELD
EXTN�,CESSPOOL,,DRYWELL,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TO �-� P.C.NO.
_PRIVATE DISPOSAL SYSTEM @ $1.00 ` CO.IMP.N0. JOB NO,
CONNECT ADDITIONAL BLDG.OR —�
WORK TO HOUSE SEWER $1,00 TRUNK PERMIT NO. ROAD PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE _ -�a
SEWER OR DISPOSAL SYS'*EM $1.00 STATE ENCROACHMANT
PERMIT NO.
INDUSTRIAL _ f
WASTE APPROVAL
CHARGES
® RAS PERMIT E3v-- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE Y , e REIMBURSEMENT FEE
I HAVEAT THIS DATE ACONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXi.ST'ING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. - -
SIGNED THIS---.—DAY OF-_ 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ ,._— BUILDING OR WOR_K___
ADDRESS - --SEPTIC TANK,SEEP PIT(S)
-- ----- _ __—_ AND/OR DRAINFIELD____
J
I D HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �
ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -CESSPOOL C DRY_WELL❑ -
WITH ALL. COUNTY ORDINANCES AND STATE LAWS. REGULATING ALTER,REPAIR,SEWER OR � !!
PLUMBING AND SEWERS. I -
I HEREBYSEWAGE DISPOSAL,SYSTEM CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CAL.iFOF.NfA OR THAT I AM THE LEGAL .OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS ❑
SIGNATURE
SEEP PIT(S) SSPOOLS
�
OF PERMITTEE
�F • '. 'VALIDATION ROBERT A. WOOD
cX.. M.0. CASH SUPERVISING MECHANICAL.ENGINEER