HomeMy Public PortalAbout5541 PAL MAL AVE_Sewer__ �Q,
IDES
76AOxD APPLICATION FRMICT-
e�Vl 7l�
fB,r
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING t��r / L
))OHI! A LAIE Count, Em
,w ADOPTEES J
WILAM
LE
AL IENSENL Sup i of Suadmp L�
LOCALITY
NE
FOR APPLICANT TO FILL IN CRD//AREST ST
LEGAL
DESCRIPTION LOT NO
MAIL a ��
[LOCH TRACT ADOPTEES
NO OF /LOO[
/12[ Of LOT NOW ON LOT CITY TEL NO
US[ OR
MUILDINO[ DISTRICT NO GROUP GK MAP PROCESSED CY
I PG
CONTRACTO
ADDRESS lz9z CONNEC ON DATA
CITY O T[ NO j STATION DEPTH
STAT[ MANHOLE REFERENCE
REGISTRATION NO COUNTY LOWSR
NO DESCRIPTION OF WORK IEE TYP O ONNt ION 'LENGTH FRdIA
NOUS[SEWER CONNECTING TO Y UR P L ML TOP L r
PUBLIC SEWER O ES w
SEPTIC TANK [ [PAI[PIT OR / •C NO G.
PITS AXO/OR DRAINPIELD O SIO OO CO IMP NO / JOB NO O
HOUSE:EWER CONM[CTING TO TRUNK PERMIT NO ROAD PERMIT NO V
PRIVATE DISPOSAL SYSTEM D) SC W BE
CONNECT ADDITIONAL SLOG OR AFFIDAVIT RMYS. ILSSXSFT RECORD IN/TR NO OAT[ O
WORK TO HOU at SEWER d :GM
OVERFLOW SEEPAGE PIT GRAINFIELD
SETH CESSPOOL ORYW[LL MANHOLE O :SIO HWY OR ST WIDENING A A MOON HOU N
/EWER M O SEOG :TATE ENCROACHMENT Z
PERMIT NO
INDUSTRIAL
��tRilO WA/T[APPROVAL
OYYITEL[LLS PERMR f $ OD CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE f[[
I HAVE AT THIS DATE A CONTRACT WITH THE NERIIM NAMED COM REIMBURSEMENT F[[
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _YROV DAT[ INSPECTOR SBIONATUR[
TO THE PUBLIC SEWER ( !.
SIGNED THIS DAY OF Ip_
OWN"OR NEW HOUSE SEWER
OWNERS AO[HT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK BEEF PIT(S)
AND /TAT[ THAT THt ABOVE IS CORRECT AND AOREE TO COMPLY AND/OR GRAINFIELD
WITH ALL COUNTY ORDINANCE$ AND $TATE LAWS R[OULATINO
PLUMBING AND S[W[RS C[BSFGOL ❑ DRYW[LL ❑
I HERESY CCRTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SKW[R OR
LIC
[NS[O AS R[OU IR[D BY LOS ANGLES COUNTY AMD AT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND CND TO DISCONNECT PLUG AND
R[SID[ IN BOVE DES ED Rt 9: O Y ABANDON HOUSE SEWER •�� I
SIO/ P[RM BACKPILL SEPTIC TANKS ❑
SEE, PIT(el u CESSPOOLS
DVAMATION ROBERT A WOOD
CK M G CASH SUPERVISING MECHANICAL ENGINEER
L" 5 9 8 6 FEB 2'7 I O D 5.0 0—
oyita. 'V
C[SOS0 1
TS808APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTbUM OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION eGILGIN0 Jr M!L a 4e
vvbO!� A IANZM Cour Eu AODR[SB L
zueE A. JUMEN. SGV f of EDJdis9 1
LOCALITY
NLAR[QT
FOR APPLICANT TO FILL IN CRou R
LEGAL
DESCRIPTION LOTHO OWNER I
MAIL
BLOCK TRACT O ADDRESS
r 117
ND O. BLOOS
SIZE OF LM NOW ON LOT CITY TSL NO —
USE OP DISTRICT HO GROUP MAP PR BY
BUILDINGS
.4 BK PO
CONTRACTOR 40
ADDRESS S , CONNECT[ N DATA
clTr nL o
RATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO 0 COUNTY LOWER
NO DESCRIPTI OF WOR PEE TYPE OF CONNECTION GTN IRON
MOUS[SEWER CONNECTING T Y CURB P L M L L
PUBLIC SEWER • so GO
SEPTIC TANK SEEPAGE PIT OR PC NO V
PITS AMO/OR GRAIN,= • slow CO IMP NO JOB NO
BE
MOUSE DISPOSAL
SAL SYSTEM
TO TRYNN PtRYI NO ROAD PERMIT NO
PRIVATE DIBPOEwL SYSTEM • ilf 00
CONNECT ADDITIONAL BL OR AFPIWV n III" RD INS" NO DATE
WORK TO HOUSE SEWER • sa o0
OVERFLOW SEEPAGE PIT GRAINFIELD 1A
[ETH C[SSPOOLDRYWELL MANHOLE• 55M NWY OR ST WIDENING Z
ALTER, N OUS
SZWER • s300 STAT[ENCROACMMLNT
PERMIT NO
IHGUSTRIAL
�����TB�T�.pp��
WANTS APPROVAL
O NEELS PERNUT j 2 OO CXAROu
AUTHOFMTION TOTAL FEE Eru CONNECTION [I[t
1 HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON RE M[M[HT FEE
HAVE
TO CONNECT TI ABOVE DUCRIB[D 1 FELLING
TO THE PUBLIC NEW A APPROVALS DAT[ INSPECTOR S SIGNATURE
SIGNED THIS Y OF 19
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
pc.
ADDRESS BUILDING OR WORK
1 HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS ATLICATION AND/OR RA S{IE PITISI
AND STAT[ THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY AND/OR DRAINII{LD
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING
PLUMBING AND S[W[RS CESSPOOL ❑ DRYWELL ❑
1 HX`NSY CERTIFY THAT 1 AM PROPERLY REGISTERED AMD/OR ALTER REPAIR SEWER ON
LICENSED AS R[OUIR[D BY LOS ANGLES COUNTY AND STAT[ OP S[WAOR DISPOSAL SYSTEM t-14-0
CALIFORNIA 0. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIGNATURE ❑
OP FERMI BACKFILL eCTANRS
6[[P PRIB) u CESSPOOLS
VAUDAgTpit—\ ROBERT A WOOD
CK M o cMH SUPERVISING MECHANICAL ENGINEER
L/x o 7 u 3 VR 14 1 o r, 5.G u - c