HomeMy Public PortalAbout6443 OAK AVE_Sewer__ :E808 1E-63
6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER. SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDINGr �'
iOT-iN Aa LAMBIE, bounty Engineer
WILLIAM A. JENSEN, Sup't of Building
LOCAL'T
NEAREST � - a! y —
S
FOR APPLICANT TO FILL IN ROS �
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DESCRIPTION TION I OT NO,-' C W°�ER
BLOCK TRAC-T 16 Y Y j�' +e �y4 ADC RE� ",�- Y �- '°rL'f->. A✓�L
NO OFI 15LO G S.
S ZE ) LOT NOW ON LOT CI?'Y
LEL_ NO
_-
USE O
SU *._DINGS x � _ ,�./ DI RIOT NO. yROUP MAP PROCESSED BY
411
en PG
CONTPACTOR d✓ � J 7 " l' ,ff% 711JI W, I /✓ ,Y 'G., .,'a
ADDRES. Q, �/ `� )'. � #e CONNECTION DATA
e ', — - - -- — - -- - -
c.7TY� r E4 f
67DN.
DEPTH
NO.
MANHOLE REFERENCE —. UPPER
CTA'TE
OUNT __-
REGI
NO DESCRIPTION OF/WORK FEE _ TYPE TY CLP
CONNECTION LF NG7H FROM '
HOL5L:SEW R COhNE 71NG TO r I � Y. CURB P.L. M.L.YU P.L.
PUBLICSEWER $.-_OO � t �_•' ____—
*.TICTNPT_ P,C.NO._,SECT
Q�
6
- (54
FITS AND/OR DRAINFI E:t.D Q $10.00 Co.IMP.NO, JOB NO.�
OUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD-PERMIT NO.
P RIVATF_DISPOSAL SYSTEM Q $3.()O'
CONNECT ADDITIONAL 'i A,FIDAVIT WAIVER A$Ev EHI'--RECORD /NST-R NO, DATE
i
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT,ORAIN IELb I 1
ExrNe s ooL,DRYWELL,MAN OLE $5.00 f;
----- -
_- HOUSE
HWY. OR 5T.WIDENING
_
ALTER.REWAIR OR ABANDON HOUSE T�
SEWER OR DISPOSAL SYSTEM @ $3,00 - --- — - - -- ---' ------- ''
..__ -_._.-._--.._.�_—. ;_____�fi._..__.._ SATE ENCROACHMENT 'y .•-'
PI RMiT NO.
INDUSTRIAL
PERMIT ! WASTE APPROVAL.
OWNER`S __ ____ ! CHARGES__
I 00
AUTHORIZATION TOTAL FEE _.y�� �eCONNE CONNECTION CHARGE FEE
-I HAVE AT THIS DATE A C-ONTR.ACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR 7C COM NECT THE: ABOVE DF.SCRI BED EXISTING DWELLING --- -;r----------r-----� --- - ---
TO THE PUBLIC SEWER. APPROVALS DATE 1NSpEC70R 5SIGNATURE
SIGNED THtS DAY OF__�. ---
0WN£R Of-= NEW HOUSE SEWER
OWNERS AGEN'i _..T __-
_.__. _ CONNE T ADDITIONAL .
A DD RISS_ BU ILD IN OR WORK
-.--�.i-
-_ „SPT C TANK SEEP,Pi7(S)
I HFREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
WITH ALL COUNTY ORDINANCES AND s,rATE LAWS REGULATING
PLU.')SING AND SEWERS CESSPOOL V DRYWELL ❑
1 III EREBY CERT'IF'Y THAT ! AM PROPERLY REGIS'FRED ANL')/OR ALTER,REPAIR.SEWER OR --- — I
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO -"----
D CCNNLCT PLUG AND
RESIDE
IN, TWpC; UFSCRIB OR€SiQENIiA'L PRCFERTY..��,dd 1AESANDDN HOUSE.. EWER
SIGNATURE
C.NFILI SEPTIC TANXS`¢ I
SEEP,Pi7lS) ❑ CESSPOOLS
VA ATION. ROBERT A. WOOD
CK M.n. cnsR
SUPERVISING MECHANICAL. ENGINEER
'
�� u .100
78A842D APPLICATION FOR PERMIT
�E808.8•E8
COUNTY OF IAS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN & LAMBIE. County Engineer ADDRESS
`— -
CASSATT A.GRIFFIN. Supt of Building LOCALITY
NEAREST
FDF
OR APPLICiAN'T FILL,$+� CROSS ST.
LOT NO. ✓:` m. OWNER
TRACT J MAIL
f �
'ADDRESS
t®,OF BLDGg
NON LOT :� CITY TEL.N0.
DISTRICT NO. GROUP MAP PR�CESSED Y
BK PG
CONTRACTOR r. .w s•s;il e . r 7
ADDRESS - ' :w CONNECTION DATA
u
CITY TEL.N0. STATION i DEPTH
JZ I a i $; STATE
❑ MANHOLE_E �R. Ci
REGISTRATION NO. [] COUNTY ', -" v �—
No. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC.SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CO ION LENGTH FROM ✓
PITS AND/OR DRAINF1ELD @ $3.00 _Y. 4URS1 P.L. M.L.TO P.L. a�
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM 0 $1.00 I CO.IMP.NO. � � JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N ,J
WORK TO HOUSE SEWER $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1.00 _PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVMIrS I PERMIT $ 21 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE vREIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS__�,_...DAY ®Fv15 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
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 0 DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLYREGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR 7NIT ;l AM THE :LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE IAL PROPERTY.' BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) [j CESSPOOLS 6
SIGNATURE _ .
OF PERMITTE
b► VALIDATION ROBERT A.WOOD
Y.R. "Bit SUPERVISING MECHANICAL ENGINEER
r 'ilk� r• ,�..