HomeMy Public PortalAbout6563 OAK AVE_Sewer__ 7fz'A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION
FA I'-
101-LN A. LAMBLE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEA REST
FOR APPLICANT TO FILL IN T.
CROSS 5
DESC`4i!�TION LOT NO. J7 OWNER ni
MAIL
BLOCK TRACT zl,' ADDRESS
NO. OF BL DGS,
SIZE OF LOTNOW ON LOT CITY
USE: OF- ---".-y-— - -- ---- -- -- I 'r TEL. NO.
BUILDINGS DISTRICT NO.1 GRj MAPPRO BY
CON
PC
TRACTOR
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ADDRESS, CONNECTION DATA
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CITY TEL I 1�11 00 N DEPTH
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STATE MANHOLE REFERENCE
iE IS RATION NO. COUNTT
Y
M
No, , DESCRIPY16N 6F ivofm FEE TYPE OFCONNECTr!�f'c LENGTH FROM
HOUSE SEWER CON NECrING TC Y. M L,TO P.1-
PUBLIC SEWER
P.C.NO.
PTfC fANK.SEEPAC,E.PIT OR
PITS AND/OR DRA(NFIELD @ S10,00 Co.Im., 140. JOB NCI
HOUSE SEWER C:ONNECTING TO
PRIVATE DiSP09AL SYSTEM @ $3,00 TRUNK PERMIT NO. ROAD PERMIT NO.
O
CONN rCTA6bITI6NAC7&LCG.OR i AFFIDAVIT WIlVE3 EASEMENT IT RECORD,INSTR.NO,
J_WORK TO HOUSE SEWER $3.00
C OVERFLOW SEEPAGE 'DRAINFIED i
EXTN..CESSPOOL,DRYWELLL.MANHOLE 0 $5.00 9K
ALTER,REPAIR OR ABANDON HOUSE HWY. OR ST,WIDENING
Z
STATE ENCROACHMENT
PERMIT NO.
INDUSTR4AL
WASTE APPROVAL
CHARG ES
OWNER'S PERMIT
C FEE E0
ONN CTI N CHARGF FEE
AUTHORIZATION[--TOTAL
I HAVE AT" THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EX15TiNG DWELLING - —
- — - .- -
,, - - - ------f----- -- --------
-m THE UBOC SEWER. APPROVALS 1 DATE ;iNSPECTOR'SSiGNATURE
SIGNED THIS D F
OWNER OR NEW HOUSE SEWicR
OVVNERS AGENT--,—
CONNECT ADDI'T IONAL
BJILOING OR WORK
SEPTIC TANK,SEEP,P;T(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND/Of?DRAINFIELD
D
A I - -
N STATC THAT THE ABOVE 15 CORRECT AND AGREE 10 COMPLY
WIT'4 ALL COUNTY ORDiNANCPS AND STATE LAWS REGULATING
PL.UMBING AND SEWERS CESSPOOL I.J DRYWELL
I HEREBY CERTIFY THAT I Ay PR0,1F.%RLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
T- -[Y SEWAGE DISPOSAL SVS!LM
_C_ ' ANG ; %-
ENSED AS REQUIRED 13Y L . I - �00 IN "tNo STATE OF
CA LIFOR N'A OR THAT 1 A LEGAL OWNER OF, ANDIN-END TO
jN PLAN D
RESILE , THE ABO��-,bq� RIBEO RFSIOV�� L PROF.��RTY� UG
ABANDON HOUSE SEWER
SIGNATURE
TANKS F
OF PFRMtTTEE
CESSPOOLS
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANfCAL ENGINEER
CK. M.O. CASH
;E@08
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ,!L D I N G
RE
7
fAIDORIESS
JOHN A- LAMBIE, County Engineer 't� - J_
WILLIAM A. JENSEN, Supt of Building L�_A_
LOCALITY
NEAREST
,
FOR APPLICANT TO FILL IN ROSS ST�'Z-4-
DF6CR,,pTICN _OT N.� j il # OWNER es 4-
"
BLOCK TRACT OGRESq
4
NO. 01 SLOGS.
'ZE_OF 1_0T ON
LOT ....CITY TEL- N 0.
USE OF D I STRICTO.N 0 MAP PROCESSED BY
OUP
---
CONTRACTOR ACOXECTI�M_D
ATADDRESs
A
Cy STATION D F PTH
CATH
H,I-I:�'-E-F- —E
BCCI
STRATTON ioN o. C OUNTY
Fe
NO. ! DES'_RIPTJ0NAF TYPE OF CONNE-T C>W., LENGTITF40�M
HOU$E SEWER CONNECTING TO Y. M,L,TO P.L.
Fl_UBL IC SEWER
B NONO 0:
SL f TANI,�.S�EE�PAGE PT T
Wi
P!Ts AND/OR ORA!NFfFLD @ $10.00 CO,IMP.NO.
HOUSE-SEWER-CONNECTING TO TRUNK PERMIT NO, ROAD PERMiT NO.
PRIVATE DISPOSAL SYSTEM $3.00 A V �l w*,v
I CONNECT ADO17IONAL BLDG.OR
DATE
-
WORK TO HOJSE SEWER @ $3-00
_
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN_CESSPOOL,DRYWELL.MANHOLE fa- s.5,00
A7U R.REPAIR OR ABANDON HOUSE
HWY,OR ST.WIDENING
SEWER OR DISPOSAL
STA:Erc,?4CROACHMF.Nr
PERMir NO.
INDUSrR!AL
W
ASTE APPROVAL
CHARGES
OVVNEPERMIT 21 00
CONNECTION CHARGE FEE
AUTHORIZATION Tcmu FEE
1 HAVE AT THIS DATE A CONTRACT' WITH THE HEREIN NAMED CON- PEfMPURSEMENT FEE
TRACTOR TOLCONNECT THE ASO VE
DESCRIBED EXISTING DWELLIN ------
70 THE-FUS 1C SEWER APPROVALS INSPECTOR'S SPIGNAT-URE
SIGNEI) THIS DA
OVO4PR(,R
NEW'HOUSE SEWER
OWNS R5 AGENT__ M
CONNECT ADDIPTIONAL
BUILDING OR WORK
A0rl'.RrSS ----- ----
SEPTIC DANK.SEEP,PIT(S)
I HERESY ACKNOWLEDGE THAT I HAVE READ 1)-415 APP41CATION AND/OR DRAINVICLO
A N 0 STATZ. THAT THF ABOVE IS CORRECT AND AGREE TO COMPLY
WITH
AL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ORYWELL
I HEREBY CERTIFY THAV I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEW ER OR
LICENSED AS REQi L SEWAGE DISPOSAL SYSTEM
,�H�R?5 BY OS ANGLES COUNTY AND STATE OF
CALIFORNIA OR. le LEGAL
OWNER OF, Al�'D INTEND TO DISCONNECT PLUG AND
,,-r'r I A'M -rHF -------
RE '*ov� BED RESIDr"'AL PROPERTY-, ABANDON H "EWE
SIDE IN, THEt /,bE:S��Rl SE R
OF PERMITTEE D
O'U
I.
BACKFILL SEPTIC TANKS
[SEEP,PIT'( ) Q CESSPOOLS
VALIDATION,- ROBERT A. WOOD
CK M.0 :�ASH,: SUPERVISING MECHANICAL ENGINEER