HomeMy Public PortalAbout5537 PAL MAL AVE_Sewer__ "`
:AAPPLICATION FOR PERMIT 1
C6DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County EuglneeT
County of Loa Angeles
WM. J. FOR, COUNTY ENGINEER ADDRESS ✓ �/ PA/rn a/ -
CASSATT 0. GRIFFIN. SUPT OF BUILDING LOCALITY f'- yy d/rp C�
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. ._
LEGAL OWNER
DESCRIPTION LOT N0. /
BLOCK �l ^ TRACT O f G AD NES9 7 ' l Y. //J v ` �U w F f
SITE OF LOT NOW ON LOTS
CITY r-I r �� TEL. N0. � �- �/� �
USE OF
BUILDINGS DISTRICT N0. GROUP MAP
BK PG
CONTRACTOR /2
ADDRESS 9pll
y ,y CONNECTION DATA
CITY m 0n r�' Vf f� TEL. NO. O STATION / 81e, S DEPTH
TATE MANROLE REFERENCE
REGISTRATION N0. l/soo COUNTY A OWE
TYPE OF CONNECTIO LENGTH FROM
No. DESCRIPTION OF WORK FEE eawt .L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER S 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00 _
CONNECT ADDITIONAL BLDG. OR Q D CO. IMP. NO. J 3 3 JOB. N0.
WORK TO ROUSE SEWER 1.00
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK ERYIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENC MENT
_ AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0.
SEPTIC TANK.SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL -- WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
-- CONNECT10>41ARGE FEE
OWNErS PERMIT S 11 00
AUTHORIZATION I TOTAL FEE OO REIMBURSEMENT FEE
IHAVE TRACTORTTOS CONNECDATE T THEA ABOVE CTED WDESCRIBED EXISTING ITH THE HEREIN A DWELLMED ING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER C`
SIGNED THIS DAY-/jtF, t9`�`� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN?�ti/ �I Y BUILDING 0R WORK "� �5.�✓
ADDRESS !?A2 <- /YI h'")spy C�. AND/ORTDRAINFEIELUPIT(S)
I E HEREBY ACKNOWLEDGE THAT i HA READ THIS APPLICATION CESSPOOL LlDRYWELL❑
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 I AMA
PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWED
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS O
SEEP.PIT(S) CESSPOOLS
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEut AIMATION
BY Al'o 8 3 5 51 SEP 2 5 4 2 :7
By
: EI
DEPUTY DEPUTY
BY BY ��//,/ Y
0 DEPUTY 1 11� PUTr
aaa+E,1I Da APPLICATION FOR PERMIT 1
DIVLSION OF B=ING AND SAFEN SEWER—SEWAGE DISPOSAL
Deymbnenf of Coantr Engineer
- Countr of Loa Angel" 7BUILDINQ ��JOHN A LAMBIE COUNTY ENGINEERGffiffiATTD GRIPFIN BUPTaPBUILDINo FOR APPLICANT TO FILL IN LEGALDESCRIPTION LOT NO BLOCK TRACTC - e-
ADDRESSow
NO OF BLDG9 TOOTRUNK
TEL NO
SIZE OF LOT NOW ON LOT
USE OF RICT NO GROUP YAP
BUILDINGS �+
PG
CONTRACTOR (,. t'S� I l BK
ADDRESS e,! CONNECTION DATA
'L-•
N DEPTH
CITY p�(I TEL NOOLE REFERENCE UPPER
n LOWER
REGISTRATION NO `
no DESCRIPTIO 0 WORK FEe
HOUSE SEWER CONNECTING TOYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER Q f 9CURB P L Y L TOP L
6EPTIC TANK SEEPAGE PIT OR
PITS AMD/OR GRAINFIELD ® f SOVERFLOW SEEPAGE PIT GRAINFIELDP RO JOB NO
EXTN CESSPOOL DRYWELL MANHOLE f2HOUSE SEWER CONNECTING TOPRIVATE DISPOSAL SYSTEM ® S1 PERMIT NO ROAD PERMIT NO
CON N ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 1100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FM REI YBURSEYENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVAIS _ DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19— CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS AMD/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL DRYWELL❑
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 I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY STAT' OF ABANDON HO USE SEWER
CALIFORNIA OR THAT 1 AN THE LEGAL OWNS THE ABOVE
DESCRIBED RESIDENTIAL P ERTY BACKF I LL SE PT I C TAN KS❑
SIGNATURE ^ SEEP PIT(S) ❑ CESSPOOLS❑
OF PERYITTE
JOHN A LAMBIE.COUNTY ENGINEER rims V ATION ROBERT A WOOD,CHIEF PLBG INSPECTOR
u o usB
Ml 5 6 119 F B 2'7. 4 A 2.0 0 R
CEOO
76AS420�' APPLICATION FOR PERM ITE�/g.'_ �AGE DISPO$�
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER- (W
BUILDING AND SAFETY DIVISION WA=
LANIXE Ceunly Paolo[.A. TEmm 1 BYp( d DYlldivp 99k nz
FCR
OR "PUCANT TO ML I1 Lor no MAIL
TRACT Q `/�7`��(�//v
NOW NO OON il �OT• CITY F. TEL NO �TJ lO
USE DISTRICT NO GROUP MAP MOG[{EED BY
/0 V eK POleedg
�� / _ YJ sy
ADDRESS O Q(/ CONNECTION DATA
CITY ry- TEL NO3 Z 3 3 STATIONDEPTH
AT[ MANHOLE REFERENCE /
REGISTRATION NO y� / couN,
LOWER
No DESCRIPTION OF WORK FEE TYPEo c [CTIDN LENGTH PROM
HOu.[SM[.CONNECTING TO Y U P L M L 10"l }
PUBLIC SEWER C Sam C NO 6
. Frlc ANK . PAG.Prt ON
PIT.AMO/OR GRAINFIELD 0 {1000 CO IMP NO O.NO O
HOUSE OWER CONNECTING TO TRUNK PERMIT NO .GAD PERMIT NO as
PRIVATE DISPOSAL SYSTEM 0 5300
CONNECT ADDITIONAL e RTO
AFFIDAVIT PMYu Wl�[n RECORD INSTR NO DAT[ O
WORKTO HOUSEBEWE R O {30
OVERFLOW SEEPAGE PIT GRAINFIELD
(ETN CESSPOOL DRYWELL MANHOLE O SSMd
ABANDON HWY OR R WIDENING H
.[W[ROR-01SPO.RV'iYfS2M O Sam Z
RAT[ENCROACHMENT
PERMIT NO
INDUSTRIAL
WAST[AANOVAI
O TT LTLEL�S PERMIT 0 CHARGE{
AUTHORIZATION TOTAL FEECOMN[CTION CMA F[E1 HAV[ AT THIS DAT[ A CONTRACT WITH THE HEON REIMBURSEMENT Ft[TRACTOR TOCONNECT TN[ ABOVE DESCRIBED EING AP!<40VAMTO TME PUELIC OMERDAT[ INSPECTOR 0 SIGNATURE
SIGNED THIS DAY OF OWN[RON NEW Hou•e SEWEROWNERSAO[NT CONNECT ADDITIONALBUILDING OR WO.KADDRESSM[REEY ACKNOWLEDGE THAT I MAV[ READ ION SEPTIC TANK .[[P PITI.1AND RATE THAT THE ASOV[ IS COM[CT AND A .LY AND/0.p11AIMFl[lD
WITH ALL COUNTY ORGINANC[S AND RAT[ LAW/ REGULATING CESSPOOL ❑ D.YW[lL ❑
FLUM•INO AND S[W[M
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTON REPAIR SEWER OR
LICtMOEO AS RIOUIR[D BY LOS ANGLES COUNTY AMD STAT[ P SM'AGE DISPOSAL SYSTEM
CALIFORM IA OR THAT I AM THE LEGAL OWNER O ND INT[ TO DISCONNECT PLUG
R■ESZDOFNIDARE [ AEAM.O1ua.EWEDR}.OV[ IB[DN[SINOON
KF LL1t['o TANKS ❑
IT
V^•
CESSPOOL.
GKOVAIMATION ROB RTA WOOD
M G GASH SUPERVISING MECHANICAL ENGINEER
1,j6O5 9 8 4Z FEB 27 1 0 D 5.00-