HomeMy Public PortalAbout6334 PRIMROSE AVE_Sewer__ ` ._.ti_.k _...--� fir''... /L' t____� •, :d,. "� {
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[:6[1069-52 APPLICATION FOR PERMIT ,,_..
'76A5G20 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSA
DEPARTMENT OF COUNTY ENGINEER
BUILDING
AG LAM$IE CoAND nnfy DIVISION
BUILDING
=1 / �'
— - — -
WILLIAM A. IENSEN, Sup'3 of Building — —LITYEFOR. APPLICANT TO FILL IN S S'r.
LEGAL
RIPTiON LOT NO.D BSC _ ONNEH
9 l 1..
BLOCK TRACT '<a F�-- ,�'_._--- .vADDRESS
NO. OF BLDG3%
SIZE F L.OT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS 9 — "— DISTRICT NO. GROUP MAP PRGCEb,SED�F3Y
CONTRACTOR Y L J\ ��� �✓ i4� _. i f
ADDRESSy, NECTION DATA
STATIONof DEPTH
CITY _.,- TEL
. - STATE MANHOLE REF_E',f2ENC6'�, �,' UPPER
REGISTRATION N " / COUNTY
No. DESC F?IP710N OF WORE FEE .� - —
TYPE OF C:COIVN ECrd`fON p -,LENGTH FROM
HOUSE SEWER ONNF4 iING 70Y CURB:; YO P L.
-_.-
PUBLIC SEWER @ S -00
SEPTI{,TANK.SEeEPAG_FIT OR _.-_
PITS AND/OR OR:AI NI'I E1.0 Q $10.00 CU.IMP NO.___..
HO Sr SEWER CONNFC-ING TO TRUNK PFRMI-fNO, ROAD PERMIT NO,
PRIVATE:DISPOSAL SYF7'EM $3.00
___ ._
3NN ADDITIONAL SLOG.OR AFFIDAVIT WAIVER CASEMENT RECORD.INSTR. NO. —DATE
V' 'JRK TO H I,SF_FEWER @ $3:00
OVERFLOW SEEPAGE:
I '
_—.- _- I
4ERFLOW E F'A CSE PIT.DRAINP'IELD I
Yl M1,.C-GSSPOuL.L'RYWELL.MAhHOLE�' $.,.00 HWY.OR ST.W'I DEN;NO
A TER RF ? F,OR ABANDON HOUSE._ ...- r
.W.#?0'R.�SPOSAL SYSTEM $3.^`J
-- - -- - - - - --- STATE ENCROACHMENT
PERMIT NO.
i.
INDUSTRIAL
WASTE AF?.PROVAL -
t J c.H,4 Y¢f EG
OWNER°S PERMIT z co -- - - -
'
CONNECTION CHARGE FEF*,,,'
AUTHORIZATION TOTAL FEE_
f HAVE AT THIS DATE A CONTRACT WITH THE: HEREIN NAMED 'SON- -----.-REIMBURSEMENT FEF.
TRACTOR TO CON".ECT THE ABOVE DESCRIBED EXISTING DWELLING __---.-__--_._._�_
TO THE PUBLIC SEWER- APPROVALS DATE, I INSPECTOR'S SIGNATURE:
SIGNED HI'3 .__.� DAY
OWNS?OR NEW HOUSE SEWER
OWNERS AGEN7_-__,___ CONNECT ADDITIONAL .__
BUILDING OR WORK
ADDRESS__-_
r- �-
ScP?'Ir..TAN(,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANU,�Cih DHAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE 70 COMPLY
WITH ALL COUNTY
ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ ORYWELL C
' HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTF_R,RE PAIR.SEWER OR
LICENSED AS REQUIRED.BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAi IRNIA OR THAT i,AM THE LEGAL CtiV NER OF, AND INTEND "f0 ---'—'--"-"--""'--"---- —'—}�-----' -'--
(� S' DISCONNECT PLUG AND
R YOFDE I MITI FE A8p �
VE DESCRIBED,RESIDEN IAL PROPERTY. ABANDON HOUSE SEWER
SA KFI_L SEPTIC TANKS
f _ :— —_ SEEP,PIT(S) CESSPOOLS (Dt
VALIDATION ROBERT A. WOOL
SUPERVISING MECHANICAL ENGINEER
CK.' M.O. CASH
ti
7E868 76R622D APPLICATION FOR PERMIT
COUNTY TMENT OF.Los ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F
LulNaRessEe,i ll losJOAN A. LAMBIE. County Engineer � - _— _WILLIAM A. JENSEN, Svg't oI BuildingALITYF�RIP
R APPLICANT TO FILL IN CROSS T.
LOT NO J' "; �Cy g,p OWNER,. MAILTRACT' 'L. „-_ ADDRESS
NO OF SLOGS. -
SIZE. OF LOT NOW ON LOT - CITY TEL. 140.
.15E OP ..�
$117LDINDi57RtCT NO. GRD!'? MAP 'ROC
R OCSS
'SF
PG
CONTRACTOR ",
ADDRESS;l-'- `>-- j .w� _^ - CONNECTION DATA
STATION _—DEPT
�H
NOCIL4.
_-___._.—_
STATE {J?'P€R..
q -CE
R:EgISTR ATIO44 NO +', nj C / �_-- COU N7Y MANHOL E.RE FERE . LOWER
NO I DESCRIPTION Of- WORK FEE
� — - _ _ __ _ TYPO�F ONNE 710 L,ENC�TH FROM
r C t N M
HOUSE SEWER ONN CTING TO ^� Y CURB P4ro .L. M.L TO P L,
PUB C SEWER �- $5.00 " p C.NO
SEPTIC TANK SEEPAGE P!' OR
PITS AND+fOK DRAINFtFLD '@ S10.00
� CO.IMP.NO, JOB NO.
—_ --- -- -- .. ---
HD ISE SCLV cR rONNECTiNf'TO TRUNK PERMIT NO. ROAD PERMIT NO.
,y
PRIVATE DISPOSAL S7 fEM b3.00
CONNECT ACU TIONAL BLS7G OR _ AFF;DAYIT WAIVER r€ASEMEHt REC:DRD. IN STR NO. '., DATE _
WORK TO HOUSE SEWER L SEEP $3.00
']VE.RFLOY+/
-- —_A_ PIT.DDR
� GE PI AINF'I LI_L.
E,XTN.CrSSF O OL.DRYWELL.MANHOLE.Q $5.00
4'
— --- yWY4OR 5 ..WIDENING
j ALTER..REPAIR'OR ABANDON HOUSE ---- ----r..-
r
- -
SEWER OR D!5P03AL.SYSTEM _ $3.00 STATE ENCROACEiMENT
—..-0
_ PERMIT Np..
INDUSTRIAL
WASTE APPROVAL
c_HARREs _
OWNER'S
PERMIT ! z oo
AUTHORIZATION TOTAL FEE -.. t-0N3�tECTIL3N CHARGE F'gE � -
1 HAVEREIMBURSEMENT FEHAVEAT THl5 DAYS A CONTRACT W17H 7wE HEREIN NAMED CON- ---- --- ---- --
RAC7')RTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ---- --p--- - - -- --- --- -- --
.O T E pU SI_IC SEWER APPROVALS DATE INSPECTORS IMATURE
SIGNED THIS ---- DAY O� .._ 1+3^ ---- ---- - --- - --
OWNER OR i NEW HOUSE SEWER
OWNERS AGENT.-
t---: ,_ _ __ CON.N.Ec7 ADDITIONAL
131! K
LDtNG OR WOR
ADDRESS. __
SEPTIC TANK,SSCP."IT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO OR DRAINFIE.LD
i
AND STATE THAT 1'HE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COi NT Y ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL DRYWELL j
I HEREBY CERTIFY THAT 3 AM PROPERLY REGISTERED ANO/OF? ALTER.REPAIR.SEWEP.OR j
LICEN5ED AS REOUIRV:D BY LOS ANGLES COUNTY AND S'TA'TE OF 'SEWAGE DISPOSAI ,STEM
CALIFORNIA OR THATjI'AM THE LEGAL OWNER OP, AND INTEND TO
DISCONNECT PLUG AND
RESIDE IN, THE ABODESCRIBED RESTDENTIAt_ PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PER MFT
t„°a.,,- .` BACKFILL SEPTIC TANKS
7EE •,--
._( L�..__ -- _ SEEP,PIT(S) i_J CESSPOOLS
VALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING NIECHANICAL, ENGINEER
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