HomeMy Public PortalAbout6538 OAK AVE_Sewer__ Af—
'E608 10
6A6420 fi3 APPLICATI N FOR PERMI
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL u
DtPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONriu I LD ING
JOHN A. LAMBIE, County Engineer ADDRESS
74
WILLIAM A. JENSEN, Supt of Building
-7-7
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CRO $T4�
T N
OWNE
MA 1 L
BLOCK TRA:�T ADO R K5S
NO OF 151-0-5
_SIZE OF LOT NOW ON
LOT C:TY TEL. NO-
USE CF
EIUI—N'-!�� DISTRICT O. GROUP MAI PROCESSED ar
BK PG
CONTRACTOP
4c-
AD CONNECTION DATA I
e/ DEPTH
CITY e I'ATION
❑
RE6157.JA1IOtJ N1, STATE
❑ COLI'NTY MANHOLE REFERENCE
41
0.. 10NOFWORK FEE TYPE,0F CONS N LENGTH FROM
HOUSESEWERCONNECTING TO Y, M L. 1`0 P.L.
j.PLjBi-fc SEWER
PiT OR
SEPT: -� JOB NO,
CA,NK.S 'AGE j ",�?
PITS AND/OR CIRAI NIIIL. @ $10.00 CO, IMP. NO. NO,
FOU E 5FvERcoNNEc-FtN-G To------ TRUNK PERMIT NO. ROAD PERMIT 41-ax"
PRIVATE OSAL SYSTEM @ $3,00rs
t5A,
- 'AODITIONAI-BLDG.OR vi,
CONNECT WA!VtR EA31IMENT RiCORD. -,N5Tii.N& DATE
WORK TO HOUSE SEWER 19- 53,00
OVERF7 ---
EXTN CCSSPOOL,DRYWELL,MAN H OLE @ 65.00
ALT£R RFPA-R�YRA - --HOUSE HWY.OR
+�I..N 1
SEWER OR DISPOSAL SYSTEM @ $3.00
—----- TE�E NffRg A iCH MVYe
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT 2; 00
CONNECTION CHARGE FEE
AUTHORIZATION -TOTAL FEE "-, -/1, -------
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
T C
TRACTOR TO CONNECT' THE ABOVE DESCRIBED EX4STING DWELLING
To THE PUSL C SEWER. APPROVALS DATE INSPECTOR'S SIGNATUR
S I G N F D T H f s Y 0 F-- 4--
OWNER OR
N HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BU iLDING OR WORK
ADDRESS
HrRFBY ACKNOWLEDGE THAT I HAVE READ THIS ALiCA1fQN SEPTIC TANK.SEEP,PIT(S)
AND,�OR DRAINFIELD
AND STAT=_' THAT THE. ABOVE 15 CORRECT AND AGREE TO COMPLY —AL
WIT"4 ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGi
CESSPOOL D
PLL'I ING AND SEW IRS, CRYWELL
M_ THAT I AM PROPERLY REGISTERED AND/ R
I HEREBY CERTIFY ALTER,REPAIR.SEWER OR
CENS':D AS REQUIRED BY LOS LF !UNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
"'A " , S c R 0
A It TC11
R TI AT I AM._ 'LE P' AND INTEND TO DI s c&NNTc-T PLUG AND
E A ED
V,
:5? IAL
PROPERTY. ABANDON HOL SE SEWER
M
R ,TTEE IIA�—K,F �LS PTIC TANKS L
S,_.P , '
CESSPOOLS C]j
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
7 OCT 2 2 1 D 7.00
LA�O
:E808 APPLICATI N FOR PER IT
6A542D 2D _
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. Cgllni( Eng in£CE F DRESS -
- - -
WILLIAM A. I£NS£N, Sup'4 a# Building
LOCALITY
NEAREST
FOR APPLICT TO FILL IN RD55 ST -- - - -_
S
--� AL.
DES::R PY ri>N L^T NC ��.a 1 p � OWNE
MAIL
BLOCK TRAC' _ / �:
FCS, 1DRE
NO
SIZE OF LOT NOW ON LOT CITY TEL. NO.
U5E OF
BU14.OINGS DISTRICT NO. GROUP MAP PROCESSED BY
SK PG
CONTRACTOR
_...-- - y '1 "_�"`b� .. _. _ �iC'�-✓.__. rte ! - .... J�� _ .."J -"-4
CONNECTION DATA
r
ST ON �� q ",i- DEPTH
CITY I
TATE c
, MANHOLE REFERENCE
RE ISIRAT('N NO �y, - - COUNTY
NO, OF WORK FEF' __-- —TYPE OF CONNE,L`TION LENGniFROM
-_Tr',011SE SEW ER.CCNNECTiT:G TO .-.-. _ -.--.i-_ Y_ ^4RA1- ___.L. M.L. OP.L. t�;
PUBLIC SEWER 12 $5'.00 fir-' -s„".'r-I P.C.NO. r-
SEPTiC TANK.SEE AGE PIT OR--^-. .--- -�_ .,j ,� - JOB NO. C
CO. IMP. No. .
PITS AND OR DRAT FIELD � $10.00
SSEWER
—�,�-.�-G-- —_--- --- �
H C+U .E S8 lv ER CONNECTING TO --�--� --__- TRUNK PERMIT NO. ROAD PERMIT NQ
PRIVATEUISPOSAL SYSTEM @ $a.00�
RECORDINSTR NO. 1_��'
DATE
^J C NNEC7 ADNR
D TIOAL BLDG Oi AFFIDAVIT WAIVER i EASEMENT_r .
- JRK TO HOUSE SEWER @ $3.00
I V
EXTN CESSPOOL,DRYWELL.MANFiOLE 0 $5,00 1
-- -- -- ---- - --- HWY.OR S7,WIDENING
ALTER,RE 1R Oft ABA 'OCN HOUSE _
..-� S.EW R IS SAL SYSTE $:1.00 ____— ��.._._ ��. _ _ e ;— --_ --__-
._-__ --_ --- _-._---, .-_ STAj •EN RIDA:CHMENT L y-J' z
_ -- - - - _
-� WASTE.APPROVAL
CHARG E6
OWNERS PERMIT --- - -
-_- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE y;: -- ---- -- - --
1 HAVE AT TH!S DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CON NECT'THE. ABOVE DESCRIBED EXr�TIt LLINC --ASri1®VACS DATE JINSPECTOR S SIGNAPURE
TO THE. PUSL IC SEWER.
SIGNED THIS__ .DAY
OWNER OR 1� NEW HOUSE SEWER `�---�
OWNERS AG.ENT_..__. __....- __..-___ .-._— CONNECT ADDITIONAL !
BUILDING OR WORK
ADDRESS__,-..
SEPT tC TANK,'SEEP.PIT(S)
u R4'.BY ACKNOWLEDGE 'THAT, Y HAVE READ TH!$ APPLICATION AND;OR I?RAINFI:LD I -
AND STA'V'E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ,ALL COUNTt' ORDINANCES AND STATE LAWS REGULATING i
PLUMBING AfJO SE�PlER'b `:.'y CESSPOOL �. DRYW ELL
1 HEREBY CERT d"Y THAT I AM PROPERLY R STEFF3 D AND/OR ALTERi REPAIR,SEWER OR
C:.E"iSED AS P F_G BY LOS ANC LF.S {:.O TY A/D STATE OF S _N{ACE bl PLJ$AL SYSTEM_ -
CALIFORNIA TnA i AM, :HE LE�.;.4' WNE F A07D INTEND TO DISCONNECT PLUG ARID
RES!D IN, E A VE DESCRIBED - IGEN AL P PEP,T1. ABA^cbON HOUSE SEWER
S GNA - --
L
-- — _
OF PER E _ J. n-•--'�`"; BAG:ktFll t SEPTIC 7ANiC5 ,
-- - - - --- "--- SEEP'PIT(5) ❑ CESSPOOLS �I
VALIDATION _ ROBERT A. WOOD
CK. MO_ CASHCASHSUPERVISING MECHANICAL ENGINEER
.
f _
� 670 5 r OCT 2 211 0 5.00-
r