HomeMy Public PortalAbout6007 RENO AVE_Sewer__ 'BA 6420 0808 - 9/73 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING :
BU
FADDRESS &C;cl
S
LOCALITY
NEAREST
CROSS
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FOR APPLICANT TO FILL IN ROSS ST.
LEGAL
SC
DE RIPTION LOT NO-14-
OWNER
MAIL
BLOCK TRACT ADDRESS 1,2, jL'
N OF BLDGS
SIZE OF LOT NOW ON LOT.' CITY TEL. NO�
USE OF DISTRICT NO.1 GROUP BK MAP P'ti 6JROCE'S�SED BY
BUILDINGS
CONTRACTOR
ADDRESS CONNECTION DATA
CITY s- STATION I!. A�.:"-4 DEPTH
STATE LIC UPPIER,
t
LICENSE N.; CLASS MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE TYPE OF
UR;�TION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L.
IPUBLIC SEWER $7.00
P.C.NO.
SEPTIC TANK.SEEPAGE PIT OR JOB NO.
PITS AND/OR DRAINFIELD $10.00 Co.imp.NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
'W-ORK TO HOUSE BE.WER AFFFDAVJT�TWAIVER 1ASIMENT RECORD. tNSTR.NO. DATE
JOVEI FIELD
RFLOW EPA-GIEP-lf-,
EXTN.,CESSPOOL,DRYWELL, $5.00 HWY.OR ST.WIDENING C.>
ALTER,REPAIR OR ABANDON HOUSE 01-
SEWER OR DISPOSAL SYSTEM $3,00_ STATE ENCROACHMENT C:)
$7.00 LLl
MANHOLE PERMIT NO.
INDUSTRIAL 13-
WASTE APPROVAL ell)
CHARGES
OWNER'S PERMIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR ToCONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS jnA'Y OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENTS CONNECT ADDITIONAL
BUILDING OR WORK z',
ADDRESS 7 SEPTIC TANK,SEEP,PIT($)
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APOfICA710N AND/OR DRAINFiELO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING
ING AND SEWERS. CESSPOOL D DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL I F C9 NIA 0 R T��IT 1p"ADI" THE LEG L OWN R OF, AND INTEND TO NN-- -- D
I PISCO ECT PLUG AN
RESIDE IN, THE DES RIB 1,TDEP*14L PROPERTY, ABANDON HOUSE SEWER
SIGNATURE T^N KS ❑El
BACKFILL
OF PORMMIE SCEP,PLL(SEPTIC
- 0 IT S) El CESS! OLS ❑
VALIDATION CK, j M.O. CASH
1. 3 2, rlCT 15 1 0
E-6®
Sa 68 99.55
APPLICATION FOR PERMIT
S 1-6
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEE}2
CA_SATT 0. GRIFFIN, SUPT OF SUILDING JLOCALITY
FOR APPLICANT TO FILL IN _doss T__
LEGAL
DESCRIPTION LOT NO
MAIL�.
BLOCK RACT - ------ .-- ADDRE S :- { �• V.L y� .,
NO. 6F BLDGS. ._:�.. - CITY {, >:, TEL, NO,
SIZE OF LOT .i }Z�- .ri X NOW ON LOT,-, -- -�---
USE O
BUILDINGS- ��� ;+;`-j� — -- -- ----- -- DISTRICT NO. j GROUP MAP
.>� PG _
CONTRACTOR
ADDRESS -; - "' , C(3MIECeTION DATA y -
CITY .c" c, r rrt FEL N0. '-r'_. ,...✓ >r _STATION f cp'• DEPTH
_.._.
+� ... J
MANHOLE REFERENCE a _UPPER
«� .., STATE:
-.REGISTRATION NO.pry✓,.�, '' ,9 - ;] COUNTY
DESCRIPTION OF WORK FEE -- --------
HOU56 SEWER,CON
hEC'iING TO — TYPE OF QQYf_NECTION LENGTH FROM
Y. CURB'; P.L. M.L. TO P.L.
PUBLIC SEWER I -"
SEFT[C TA'4K SEEPAGEPI'S`OR -
I PITS AND/OR DRAINEIELU cr
I OJFRFLOW SEEPAGE PIT, DRAINFIELD - P C. NO,
XfN_CESSPOOL,DRYWELL,MANHOLE ( $2.001 CO. IMP. N0, > h�, ;> 108 NO.
HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL-SYSTEM k'. $LOO � TRUNK PERMIT NO, ' ROAD PERMIT N0. �
CONNECT ADDITIONAL BLDG..OR NATE ENCROACHMENT
WORK TO HOUSE SEWER 'a- S-1.00 1 PERhYi1"140.
ALTER,REPAIR OR ABANDON HOUSE � INDUSTRIAL--- - -- ---' ----
SEWER OR DISPOSAL `S TEM �c- e 1.00
- - _. __--_-- _.-- -- —'�--- ---- WASTE APPROVAL
i
I
CHARGES
00CONNECTION CHARGE..FEE
OWNER'S PERMIT
.-- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE t9 OVALS CATS NSPECT0R'SS13NATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAFitD CON- t�PPR__.-_
TRACTOR TO CONNECT THE ABOVE. DESCRIBED 'EXISTING DWELLING
TO "rHE PUBLIC SEWER, - -- NEW Fi0U5E SEWER
SIGNED THIS _.—.DAY dF �—, �9CONNECT ADDITI NAC
OWNER OR �",`��' �� BUILDING OR WOK
OWNERS AGENT ill
SEPTIC
a -- SEPTIC TANK,SEEP,FIT{Sy
AND/OR.DRAINFIELD -
I. HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI ATIONCESSPOOLL DRYTVELLI]
� I..
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '
,REPAIR,
._ --T--- ---
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTERSEWER OR I
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
.`--`---------. --i-- ---- ------------
t HEREBY CERTIFY THAT [ W PROP- LY REGISTERED AND/OR DISCONNECT PLUG AND '
LICENSED AS RFQ,IRED 8Y S ANGIEE E COUNTY AND STATE OF
ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 A ?t-E LEiGA OWNER OF THE ABOVE --- -- -- .------------
DESCRIBED RESIDENTIAL P PER " $ EACk.FILL SEPTIC TANKS t
SIGNATURE SEEP.PIT(S) `uI CESSPOOLS 0
-- –— –_ ..--'--------I.
OF PERMITT
I
JOHN A. LAMBIE, COUNTY NGINEER f VALIDATION ROBERT A.WOOD, CI-IIE:F PLFG. INSPECTOR
C"K.e;' ' M. Q. CASH
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