HomeMy Public PortalAbout6012 RENO AVE_Sewer__ E808
SAA642D-6! APPLICATION FOR PE MIT
42
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMEIJT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING r
JOHN A. LAMBIE, County E fneor ADDRESS a 41
WILLIAM A. JENSEN, Sup'! of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL. IN CRDss ST
LEGAL
DESCRIPTION LOT NO. / F OWNE#
BLOCK TRACT J ✓j MAIL
✓ ADDREE,
NO,OF BLOGS.
SIZE OF LOT NOW ON LOT CITY TEL NO. .s r°
USE OF
BUaLDSNGS f t DISTRICT N0. 'GROUP MAP PROCESSED BY
I. JBK PG
CONTRACTOR
ADDRESS. CONNECTION DATA
CITY y ;, TEL.I90. �STATlON DEPTH
'.r '.STATE MANHOLE REFERENCE. UPPER
REGISTRATION NO - ® COUNTY LOWER
NO. DESCRIPTION OFWORK_ FEE
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER 0,-$3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRA.INFIELD a
EXTN..CESSPOOL.URYWELL @ S2.00
HOUSE SEWER CONNECTING TO _
R.G.N0-
_ PRIVATE DISPOSAL SYSTEM @ $4.00 CO.IMP. NO. JOB N0, U
'` CONNECT ADDITIONAL 7. TRUNK PERMIT NO. ROAD PERMIT NO. OC
WORK TO HOUSE SEWER p.00
ALT ER,R.EPAIR OR ABANDON HOUSE STATE ENCROACHMENT ' - _
SEWER OR DISPOSAL SYSTEM @ 5 .00 PERMIT NO, LiUj
INDUSTRIAL `Y i-
WASTE APPROVAL
CHARGES z
+�
OWnWS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE - - C� �:.' ^REIMBURSEMENT FEE
I HAVE AT S DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTNG DWELLING APPROVAIS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS DAY 0l°- 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGEN7 BUILDING OR WORK
ADDRESS SEPTIC TANK:SEEP.PITS)
AND/OR DRA.INFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS: SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTAL:PROPERTY.-. BAOKFitt SEPTPC TANKS ❑
SIGNATURE SEEP.PITIS) b CESSPOOLS
OF PERMITTE �.
VAL WATIO ROBERT A. WOOD
C5. *.a. CASH _ SUPERVISING MECHANICAL.ENGINEER
U 2 1 1 6 AIJG 5.01 tJ
,j
E808 APPLICATION FOR: PE MIT
2D L�
bA 642
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION A6DRE�8G - . s
TiHN A, LAMBIE, County Engineer
W'TLLIAM A. IENSEN. 5up'I of Building LOCALITY a G
FBLOCNEAREST
K
OR APPLICANT TO FUl IN CROSS ST
AL
LOT N0. -% .f_ OWNER z ;'r f
f MAIL
TRACT r- - ADDRESSOF BLDGS.NOW ON LOT CITYX TEL. NO'_; DISTRICT N0. GROUP MAP PROCESSED BT
.BK PGR `� "! PB•r' CONNECTION DATA
CITY TEL.N0. e_ r,,, g:7 '.0 .s STATION DEPTH
-' STATE MANHOLE REFERENCE UPPER
REGISTRATION NO, j" j. LJ COUNTY LOW5R
NO. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO _
PUBLIC SEWER @° 3.00 TYPE OF CONNECTION LENGTH FROM
PITS ANDEPTIC /OR DRAEIPNFIELDT OR @ $3000 Y. CURB P,L. M,L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD �
EXTN..CESSPOOL.DRYWELL $2.00 n.
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ X1.00 CO. IMP. N0. JOB NO. V
CONNECT ADDITIONAL41MONIMTRUNK PERMIT NO, ROAD PERMIT NO. w
WORK TO HOUSE SEWER 4.00
ALTER,REPAIR OR ABANDSTATE ENCROACHMENT
EWER OR DISPOSALSYSTEMON HOUSE G S.00 PERMIT N0.
INDUSTRIALp�,c
_WASTE APPROVAL
���w�+
�r _ CHARGES Z
OWNER'S PERM $ 1 21 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE - >' REI MBURSEMENT FEE
IHAVE AT TRACTORS DATE A CONTRACT WITH THE HEREIN TOTHE ABOVE DESCRIBED EXISTING NAMED
CON-
APPROVALS
ACTOR TO CDATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS—DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS, CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I 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,PROPERTY. BACKFILL SEPTIC TANKS I_]
SIGNATURE W, SEEP.PIT 5 C] CESSPOOLS
OF PERM.ITTE r'� #�✓.
VALIDATION _ ROBERT A. WOOD
CK. M.o. CASX SUPERVISING MECHANICAL ENGINEER
t