HomeMy Public PortalAbout5929 RENO AVE_Sewer__ 76A 642D — CE808 — 9/73 APPLICATION FOR-,.,PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION 7REDDRESS
FOR APPLICANTTO FILL IN r-LE77-kc--'I—IPTIONLQT
NO _,• � �..t..-
MAIL
ADDRESS
OCK TRACT j r _
aJ NO. OF BLDG5. TEL. NO.
SIZE OF LOT _� X )' �:Ja-' NOW ON LOT CITY
USE OF DISTRICT NO. GROUP MAP y,.. ESLj
BUILDINGS BK Pa
EONTRACTOR ✓
ADDRESS �7 .% •r✓ CONNECTION DATA
STATION �' _� _.� ;t DEPTH
CITY tTEL`. ---Y,3
STATE
STATE MANHOLE REFERENCE - "t /
LL�ORW1�EE1VRLC
LICENSE NO._ GLASS _
_
-
NO. DESCRIPTION OF WORK FEE TYPE OF 4y1NNEGTION LENGTH FROM
HOUSE SEWER CONNECTING TO $7.00 L.+'
Y. CURBS' P.L. M.L.TO P.L.
�� PUBLIC SEWER L.+' .} , - P.G.NO.
SEPTIC TANK.SEEPAGE PIT OR CO.IMP.NO. _��-�' JOB NO.
PITS AND/OR DRAINFIELD $10.00 J /
HOUSE SEWER CONNECTING TO y TRUNK PERMIT NO. ROAD PERMIT NO.`,�%
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.QR AFFIDAVIT *A1Ve■ ll"N'Ili RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER $3.00 CL.
_ _ O
OVERFLOW SEEPAGE PIT.DRAINFIELD V
EXTN..CESSPOOL.ORYW ELL. 0 $5.00 HWY.OR ST.WIDENING
ALTER.REPAIR OR ABANDON HOUSE _ O
SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT 8PERMIT NO. (y
MANHOLE $7.00 INDUSTRIAL
WASTE APPROVAL Z
CHARGES r
OWNER'S PERMITsoy
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE
REIMBURSEMENT FEE
I HAVEAT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF-19—
OWNER
F 18_OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS - SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
—
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ❑ DRYWELL ❑
PLUMBING AND SEV{A AS. ---
t HEREBY CE IFY THAT I AM PR PERLY REGISTEJ9ED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS EOUI RED BY LOS A LES COUNTY ND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFCStNIA TH A7 1 qM THE LE 14 OWNER OF AN}�J INTEND TO DISCON NEGT PLUG AMD
RESIDE IN, T ABOVE DESCRIBED RESIDENTIAL R `ERTY. ABANDON HOUSE SEWER 1
SIGNATURE /"� BACKFILL SEPTIC TATjKf4.�❑ '
OF PEQMTTTEEu -� �m .�.S}EEP.PITS) q,.IC SSW6OLS ,
ALIDATION CK' M•0' CASH
i1
i56N"fflf G1 U 1 rJ.vUAk
6A 6420-CE808-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING r'
ADDRESS
LOCALITY i a
NEAREST
FOR APL T TO FILL IN CRDSS BT.
-- --_ -
LEG
DESCRIPTION LOT N OWNER,°:
MAIL C.
�,•. ,.
BLOCK TRACT ADDRESS C' -Zz,
NO. OF BLDGS. ` r xry•"`
SIZE OF LOT NOW ON LOT CITY` - TEL. NO.
115E OF "`�-
BUILDINGS •� DISTRICT NO. GROUP I MAP ROCESSED BY
-_
BKIDA
�P3
CsONTRAC ORA`�'�.. .L�
ADDRESSDATA
CITY �---y �' TEL. NO. �l STATION DEPTH
STA TE I , LIC i' MANHOLE REFERE E UPPER
LICENSE NO.: _/-�C t..„ �,-y CLASS _ LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNE ION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER 0 $7.00
P.C.NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $10.00 CO. IMP. NO. JOB 1 -
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAlvE■ EASEMENT RECORD.INSTR.NO. DATE O
0
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD OL,
EXTN.,CESSPOOL,DRYWELL. a $5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR D_ISPO_SAL SYSTEM a $3.00 STATEENCROACHMENT
MANHOLE ! $7.00 PERMIT NO. q,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT t —
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE - --
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAME CON- REIMBURSEMENT FEE
TRACTOR TO COV NECT THE ABOVE DESCRIBED E]LL>►T�4K'G"DWEjLLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR' IGNATURE
SIGNED THIS OF 19 ----�
OWNER OR NEW HOUSE SEWER
OV1�l€R GENT
e+" CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
FLU MBING AND SEWERS. CESSPOOL ❑ DRYWELL
I HEREBY CER F FY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS RE )RED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR AT 1 AM THE LEGAL OWNER F, AND NTENO TO ----
DISCONNECT PLUG AND
RESIDE IN, THE BOVE DESCRIBED RES I DENTIAIN PROPE TY. ABANDON HOUSE SEWER
SIGNATURE • [
__.
' �,�, �,�>�Y,_ - ��. , BACKFILL SEPTIC TA ❑
OF PERMTTT EE _ _._ -- --" SEEP.PITIS).. E3 CE=q' LS ❑
VALIDATION *. M,O. CASH
45 �:w�11'TU 1J