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Home My Public Portal About5516 PAL MAL AVE_Sewer__ ;:m;sI,BM APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL DMpmrbn@f of Camlp Engine �// j / CounW Of Las Ange1BE BUILDINBUILDING L I•A'/T 4.. JOHN A LAMBIE COUNTY ENGINEeR m CASBATT D GRIFFIN 8uP T Or BUILOIHD LOCALITY FOR APPLICANT TO FILL. IN NEARESTRSST LEGAL DESCRIPTION LOT NO Z. G ' /Or OWNER MAIL SJ BLOCK TRACT ( ADDRESS SIZENO OF BLOT! CITY TEL NO USE OF LOT NOW ON LOT BUILD I DISTRICT NO GROUP YAP CONTRACTOR T BK P'�� CONTiACTOR .J/- ADoaEss CONNECTION DATA CITY TEL NO STATION DEPTH NHOLE REFERENCE UPPER ❑ STATE LOWER REGISTRATION NO ❑ COUNTY No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TY OF CONNECTION LEN H FROM PUBLIC SEWER 5 3 SO Y CURB P L III TO P L SEPTIC TAN K.SEEPAGE PIT OR PITS AND/OR DRAIMFIELD $3 00 OVERFLOW SEEPAGE PIT ORAIXFIELD AIDE NO EXTN CESSPOOL DRYWELL MANHOLE ® $2 00 CO IMP NO 1D5 NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® S 1 00 TRUNK PERMIT NO ROAD PERMIT NO CON N ECT ADDITIONAL BLDG OR STATE EMCROACHME WORK TO HOUSE SEWER ® $I 00 PERMIT NO ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM 100 WASTE APPR L CHARGES I C ECTION CHARGE FEE OWNERS PERM s 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN HAYED CON. APPROVALS DATE INSPECTOR SSIG TURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THI AY OF 19— CONNECT ADDITIONAL OWNER AGE A / BUILDING OR WORK OWNERS AGE b � M/I'C.1��+ SEPTIC TANK SEEP,PIT(9) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ ORYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAU7 PR PERTY // BACKFILL SEPTIC TANKS TANKS f/(fj 4W!_IJs-1/!J/F'�/ SEEP PIT(S)❑ CESSPOOLS 91GNATURE r/ A[iy>_,vtJ4nJ OF PENN[ - - JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD,CHIEF PLBG INSPECTOR 4-o—M M23 4 200 4 f Dile"` ::Ka atim .,; APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County EngfAGW County of La Angola BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS m CASSATT O GRIFFIN SUP T OF BUILDING LOCALITY C FOR APPLICATO FILL IN CROSSREST NT T le s `E`"Lr0 DESCRIPTION LOT XO • OWNER MAIL BLOCK TRACT 2 ADDRESS 4 NO OF BLDGS CITY TEL NO SIZE OF LOT NOW ON LOT BUILDINGS DI M68 DISTRICT NO GROUP YAP USEo BR P6 CONTRACTOR ADDRESS1_1 /r CONNECTION DASA I / CITY Jail If#Z ri LI TEL NO e STATION DEPTH MANHOLE REFERENCE L w } UPPER ❑ STATE i'/7///�T/V/NC- LOWER W REGISTRATION NO ❑ COUNTY I NO DESCRIPTION ORK FEE to /ffp .'f'oyTYPE OF CONNECTION LENGTH FROM PUBLIC SEWER HOUSE SEWER WER CONNECTING TO !S 90 Y CURB P L Y L TO P L � SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® $S 00 OVERFLOW SEEPAGE PIT DRAINFIELD P C NO EYTN CESSPOOL DRYWELL,MANHOLE @ $2 00 GO IMP NO JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® S 100 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER ® $1 00 Q Q PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM ® $1 00 WASTE APPROVAL CHARGE! CONNECTION CHARGE FEE OWNERS PERMrf S 1 00 AUTHORIZATION I TOTAL FEEREIMBURSEMENT FEE PO I HAVE AT ATE A CONTRACT WITH THE HEREIN NAMED N- APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CEXISTING ABOVE DESCRIBED ISTING DWELLILI NG TO THE PUBLICIC O SEWER MAZY ROUSE SEWER SIGNED THIS DAY OF 19— CONNECT ADDITIONAL *-;Irl OR BUILD]Na OR WORK OWNER! AGENT SEPTICTANK SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ ORYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LO! ANGELES COUNTY ANO STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP TY BACKFILL SEPTIC TANKS SIGNATURE SEEP PITS)❑ CESSPOOLS OF PERMITTEE JOHN A LAMBIE.COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR 4 7 69° run29 4 200 D