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Home My Public Portal About5606 PAL MAL AVE_Sewer__ s&Zsea II $$ APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFEYY SEWER—SEWAGE DISPOSAL Departasnt of County Engbww County of Loc Angel" BUILDING �.' // / JOHN A LAMBIE COUNTY ENGINEER ADDRESS V C/ m CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FijEi III] CROSSS ST DESCRIPTION LOT NO OWNER BLOCK TRACT MAIL (V j ADDRESS x G NO OF OLD A CITY 1,_eh TEL NO SIZE OF LOT O NOW ON LOT L.A USE I DISTR�O GROUP YAP USEOBUILDINGS DXG! BK PG CONTRACTOR L I-QZA ADDRESS Olt CONNECTION DATA i TION DEPTH CITY NO YA OLE REFERENCE UPPER ❑ STATE LOWEAP REGISTRATION NO ❑ COUNTY No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TOTYPE CONNECTION LENGTH FROM PUBLICSEWER @ s 3 SO Y URB P L M L TO P L SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® S S 00 OVERFLOW SEEPAGE PIT DRAIN FIELD P C je EXTN CESSPOOL DRY-WELL MANHOLE $Z 00 CO IMP NO JO&4O HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO OAD PERMIT NO CONNECT ADDITIONAL BLDG OR �,L STATE ENCROACHMENT WORK TO HOUSE SEWER ® S 1 00 (JV PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q s 1 00 WASTE APPROY CHARGES CON R ION CHARGE FEE O{NNER'S p1�bIIT s t o0 AMORPLATION TOTAL FEE IMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR S NATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THI DAY OF M CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGSN SEPTIC TANK SEEP,PIT($) ADORES AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL ROPERTY BACKFILL SEPTIC TANKS C1SIGNATURE SEP PIT(S) ❑ CESSPOOLS❑ OF PERMITTEE n JOHN A LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT A WOOD CHIEF PLBG INSPECTOR DK L&2 u.7 A FEB 9 4 2.0 0 � 1 iEv6A o'°*+ - APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BmLDINo JOHN A LAMBIE COUNTY ENGINEER "O°"[°' COLEMAN W JENKINS SUPT OF BUILDING LOCALITY FOR APPLICANT TO PILL IN REARLiT IPRINT OR TYPE ONLY) cHOBB ST LEGAL DC¢CRIRTION LOT NO OWNER MAIL 1LOCK TRACT ADORES NO OR swag SIZE OF LOT NOW ON LOT CITY TEL NO USE OF'BUILDIDISTRICT NO OUP LAS! SK MAP PROCEf E0 BY QONTRNO¢ J F� GpHTRADTDR _ 'o YZ wooiu CONNECTION DATA CITY T¢L NO O STATION DCRN STATEY LIC UPPER LICENSE NO p CLASS MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE or CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURE P L ML TOP L PUBLIC SEWER iB Go EPTIC TANK BE [PAOE PIT OR PC MO :ITS AHD/OR pRA INFIELD O SI000 CO IMP NO JOB NO HOUSE!EWER CONNECTING TO PRIVATE DISPOSAL SYSTEM O SB 00 TRUNK PERMIT NO �_ /ROAD PERMIT No a CONNECT ADDITIONAL BL GO ON AFFIDAVIT RYE[• [U[ROR ^RLCOIID )NSTR ND OAT[ Q WORK TO HOUSE BCW[R C SJOO v OVERFLOW SEEPAGE PIT DRAINFICLD [ITN CESSPOOL DRYWELL MANHOLE O 55M ad NWY OR BT WI NIMp O ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM O SB OD STATE ENCROACHMENT G YII� PERrIT No ly V�TJ INDUSTRIAL U0 H �ELE��}}��pp�� WASTE APPROVAL Z �{OEA1p�}EI RSrE FEEMIT 00 CHARGES AUMO[1{4f111ON TOTAL ME &V CONNECTION CHARGE PE[ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON RCIMBURB[M[NT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING AOVA� TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF IG_ OWNER OR NEW HOUSE SEWER OW NCRS AGENT CONNECT ADDITIONAL AO°REBS BUILDING OR WORN 1 HEREBY ACKNOWLEDGE THAT 1 HAVE P[AD THIS APPLICATION SEPTIC TANN BEEP PIT(S) ANO/OR DRAINFICLD WIT BALL THAT THE ABOVE IS LAND S AND AOR[[ IC COMPLY WITN ALL COUNTY ORDINANCES AND STATE LAWS R[°ULATINO ❑ PLUMBING AND SEWER! CESSPOOL ❑ ORYWCLL 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER SMH[IIPBEWER OR LICENSED A8 REQUIRED BY LOS ANGLES COUNTY AND STAT[ OFB [ [ CALIFORMIA OR THAT 1 AM THE LIEOWNER • AND INTEND TO DISCONNECT PLUG AND R[SI°[ IN THE AB E DESCRIB NC D[NTI ILROFERTY ABANDON HOUSE SEWER 810p1 APEHMRTCC BAC Fl LL B¢PTIC TANKS ❑ BEEP PIT ISI ❑ CESEPOoLS ATION JACK ALLEN CKY17 CASH SUPERVISING MECHANICAL ENGINEER aW '[ 1 6 2 HN 4 1 O D 6.0 0" mv