HomeMy Public PortalAbout5125 PAL MAL AVE_Sewer__ 16A642r)
3&E-663 11-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAN181E, COUNTY ENGINEER
CASSATT D. GRIFFIN, Sup,-r or,BUILDING LOCALITY
V
NEAREST
I'OR APPLICANT TO FILL IN CROSS ST,_'.'_"
LEGAL
DESCRIPTION LOT NO,
OWNER
MAIL
BLOCK TRACT ADORE
NO.OF BLDGS,
NOL CITY 'TEL NO.
SIZE 0 a
DE
E
9
Department f Engineer
Angeles
COUNTY
ENGINEER P 0 t 0 COU
C n of LOS
N A A�%i E3 IfE, CC)
S S rT 0
A GRIFrI N, Sul'
L
USE OF
-BUILDINGS DISTRICT NO GROUP MAP
PG
CONTRACTOR
CONNECTION DATA
ADDRESS
STATION
--------
CITY DEPTH
TEL NO,,
MANHOLE REFERENCE ____q_p_pER
STATE LOWER
REGISTRATION NO, COUNTY
DESCRIPTION OF WORK FEE
14 C,U S S EA."E R-C.ONNECTI NG TO----------- TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L, M,L,TO P.L.
PUDLIC SEWER 3.-5o
SEPTIC TANK,SEEPAGE PIT OR
PITS AND OR DRAINFIELD i $3.00
OVERFLOW SEEPAGE P11,DRAINFIELD P. C. NO.
EX-fN.,CESSPOIDL,DR.Y',VELL,NltN401,F0) 0CO, IMP. N0, JOB NO.
. ---- - $
H6USESEWERCONNECTING
TO
PRIVATE DISPOSAL SYSTEM TRUNK PERqTT NO. ROAD PERMIT NO.
CONNECT 7ADUITIONAL RLDG.OR i STATE ENCROACHMENT
WORK TO HOUSE SEWER $I.D.-
_ _ --- E�'- _._ 11-- _PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEVVER OR CiSPOSAL SYSTEM 1.00
J WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTNACHEREIN NAMED CON-T WITH THE APPROVALS DATE INSPECTOR'SSiGNATURE
j
TRACTOR TO CONNECT THE ASCVE DESCRIBED EXISTING DWELLINO
TO T t E PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THISDAYCONNECT ADDITIONAL
OWNER OR -BUILDING OR WORK
OWNERS SEPTIC TANK,SFEP,FI f(S)
ADDRESS-- AND/OR DRAINFIELD
LI HEREBY ACKNU\VLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLO DRYA'ELLC
AND STATE TH'Al' THE ABOVE 15 CORRECT AND AGREE TO COMPLY
STATE
ALL COUNTY ORDINANCES AND LAYS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SFWERS, _-EWAGE DISPOSAL SYSTEM
I HrPEBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS RYQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE A95-NOON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEP-f!C TANKS L'
SIGNATURE SEEP, PIT(S)_L].CESSPOOLS 0
OF PERMITT
JOHN A. LAMBIE, COUNTY ENGINEER VAIJDATIO.N.____', ROBERT A. WOOD, CHIEF PLBG, INSPECTOR
4CA
SH
HDEPAUTRIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX. COUNTY ENGINEER I ADDRESS Sly
FOR APPLICANT TO FILL IN LOCALITY
BUILDING r NEAREST r� I
ADDRESSCROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
EAREST • A
NV�f/p S
CROSS ST.
ECE ED -Ready for Inspection PATE ISS ED
OWNER1-4
MAIL rx X4g U#E ONE OCCUPANCY -OfYkP"
ADDRESS ,�/,�, � A ,%'P(_�,& �L�. BK PG
CIT TEL:NO. d u.2 50VO I I G
CONTRACTOR t > CO.IMP.NO. �OV r
ADDRESS w� r '' a ,JOB NO.
e
CITY ��f. i T STATE TRUNK PERMIT NO.
REGISTRATION NO/ ti ® COUNTY ROAD PERMIT NO. 7 Al-
LEGAL STATE ENCROACHMENJ,;:�-
DESCRIPTION LOT NO. n PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 7 NO.OF NOW ON LOTS CHARGES
USE OF
BUILDINGS a CONNECTION CHAR FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.50 S 1 RECEIPT NO. I TE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD(.OR ��y EXCEP 0 RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO-
DA*T I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION E�/ f S DEPTH 4 C)
CESSPOOL—D RYW ELL t�
SPECIAL CONDITIONS ONLY 2.00 $' MANHOLE REFERENCE LOWER
TYPE CTION LENGTH.FROM 2-0
OWNERS PERMIT ; I 00 -V -CURBS --P&. M.L.TO P.L. �7
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED'
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING. APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING T0. THE PUBLIC SEWER rl
SIGNED THIS..,�. .._..DAY OP.a0z&l .--_1 NEW HOUSE SEWER A`�,,e>, . f-
OWNERi CONNECT ADDITIONAL
BUILDING OR WORK
SEPTIC DRAINFIELEEP.D IT (8)
.... .J AND/Olt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LI- CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED'. DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM E LEGAL OW
ER OF THE ABOVE DESCRIB D RESIDE PROPERTY. . BACKFILL SEPTIC TANKS
f]J�yon/'
SIGNATURE r SEEP.PIT(S)[] CESSPOOL
OF PERMITTEE..:._ .. _.. . . _... _. _
76M" 663 7/53