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HomeMy Public PortalAbout6430 OAK AVE_Sewer__ ,:F:808 101,032 �� 78ii 842 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMEIE, County- Engineer ADDRESS WILLIAM A. JENSEN. Supt of Building FOR APPLICANT TO FILL IN CROSS ST. DZSTION -OT Na./r OWNER �. - — -- - 114,L .� BLOCK iRAC1 AODREsS NO. OF BJ.DCS S. _ S!LE. OF LOT NY%Yd ON L.OT' C ITY TEL. NO, USF OF - BUIL7INGS r_J'p-'E �{il[.y . �— DISTRICT NO_ GROUP MAP PROCESSED BY 9K PG CONTRACTOR' i +Y "�''Ce%u-f/ e ;rd/�✓"d� _ -- -. ADDRESS..�C*.3, c" CONNECTION DATA CITY ,V ✓S sqEL. NOSTATION EP7H _- -- STATE - --- ----- -- --- _ --- -- 'iJPPER;-_. REGI BT RATI Old NO. ❑ COUNTY MAN}{OLF REFERENCE 3..9WEPR NO DESCRIPTiOt,3 Off" WORK £ -- �. TYPE OF CONNECT LENGTH FROM HOUSEBS S£WCR CONNECTING T'O I Y. CURB P,L. M.L.TO P.L. CJ .00 i --� --_-- P LIL EWER $5 - --TI - — i 7!C TANK,5££ AGE 'IT OR CO.IMP NO ? NO T A.di C2 DRAINFILLD $10.00 JOB NO. -- ---- -"- 4 -�-_T HOUSE SFW R CONNE CffNG Te- TRUNK PE`t2Mi�T NO.— ROAD PERMIT N4:.Te- PRIVATE DISPOSAL YETEM @ $$.Do I ---_ .— _-_NAL __- I. GDNhE.'7 ADO.T7ONAL B.L6G Oft AFPPDAV17 J WAIVER E0.5Ea{E HY 1 -RECORD,-[PISTR NO DATE. .d WORK TO HOUSE SEWER @ $3.00 - 4 _ - S ��OVERFLOW SE EPAc�E Pt DRA{l4fi?z'J _.__.�._._._..— z EXTN CESSPOOL,DRYWELL',LAA NHOLE $S.GD HOUSE SE HWY.OR STWIDENING - ALTER,REPAIR OR AEA NDO PJ i 7 . _- SEW'£R OR DISPOSAL.SYSTEM 3.00 5T.QYE ENCROACHMENT - PERMIT NO. - ---- - ----- --- --- --- - ---- ------ __- INDUSTRIAL, -. i WASTE APPROVAL CHARGES OWNEE;7` PERMIT - - ---- 00 --- -- - --- ----- - - -- --- --- --- - — --- .,`. CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE -'------ - - -- - --- ---------- ---' -- I HAVE A7 THIS GATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING OWELA.It G TO,THE.PUSL IC SEWER. APPROVALS DATE I INSPECTOWSSIGNATUR£ SIGNED THIS—_._—DAY OF----- OWNER F ----OR OWNFR NEW HOUSE SEWER -__- OW NFR',�AGENT______ ..-. ADDR _S_ _ BUILDING OR WORK._CONNECT AL __ --- SEPTIC TAN K,S."EP P'!T 5) . I HEREBY ACKNOWLEDGE HAT I HAVE READ THIS APPLICATION ANO%OR.LTRAINF ECO ,0.N TATE. THAT THr ABOVE S CORRECT AND AGREE' .O COMPLY W17 A.I. CC 1NT'/ Of!NANC,ES AND STATE LAWS REGULATING I - 4 - PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ f I HEREBY CERTIFY THAT 1 AAS P. OPERLY P.EGISTERED AND/OR ALTER SR R PAIR, EWEOP -- {r,-NS!_D AS REQUIRED BY LOS AN GLE.S COUNTY AND STATE: OF SEWAGE DISPOSAL.SYSTEM CALIFORNIA OR TEAT I AM THE LEGAL.OWNER OF, AND INTEND TODISCONNECT DISCONNECT REBID IN. TfiKOVE DESC1 ByE .REG ENTIAL PROPERTY. ABANDON HOUPLUG AND SE SEWER SIGNATURE e 'EE ETANKS GIP P£RMJT'1 - � a-'1� ' BAC;.KI=IL�5PTiC T " �"__" -_. — _ SEEP.PIT iS) [� CESSPOOL, VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK: M.0, CASH t.lt f3 ii J _ -14 980828so APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 1offN A. LAMBIE, Countg Engineer ADDRESS CASSATT D. GRIFFIN, Sup f of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL ---- - ---— - DESCRIPTION LOT NO. OWNER BLOCK ' TRACT�y MAIL _ ADDRESS NO.OF BLDGS< SIZE OF LOT _ NOW ON LOT _ - CITY TEL. N0, USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY/ BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY 'TEL.NO. STATION DEPTH -- ym� STATE MANHOLE REFERENCE -'UPPER:' REGISTRATION NO. i LI COUNTY - ....-Lpq NO. DESCRIPTION OF WORK FEE r HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF ONNtCTION LENGTH FROM ._ SEPTIC TANK,SEEPAGE PIT OR Y. /CURB P.L. M.L.TO P,L. - PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO Ctl.IMP.N0. ,/ -r Il ,'� OB NO.. PRIVATE DISPOSAL SYSTEM @ $I-00 CONNECT ADDITIONAL BLDG.OR TRUNK PER NO. ROAD PERMIT NO WORK TO HOUSE SEWER $1.00 ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER_OR DISPOSALSYSTE:M @ $.t:OO PERMIT NO. INDUSTRIAL - - — WASTE APPROVAL CHARGES OWNERS 'PERM 5 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER, SIGNED THIS DAY OF__ 19 NEW HOUSE SEWER O'WNER OR CONNECT ADDITIONAL —� OWNERS AGENT--.----,---- BUILDING OR WORK ADDRESS-­L­ SEPTIC TANK,SEEP.PIT($) - _- - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL © DRYWELL CI WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED. AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS [I SIGNATURE' _ SEEP.PIT(S) ❑ CESSPOOLS OF PERMITTE VALIDATION ROBERT A. WOOD CL M.0. CASH SUPERVISING MECHANICAL.ENGINEER