HomeMy Public PortalAbout6022 RENO AVE_Sewer__ i6AE-6
F... 63 H-155APPLICATION FOR PERMIT
1
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DIVISION OF BUILDING ,AND SAFETY SEWER—SEWAGE D I S POSH L
Deportment of County Engineer
County of Loa Angeles JADD
UILDING o'
JOHN A. LAMBlE, COUNTY .*-.ENGINEER RESS C _-
CASSAT`T D. GFt I'r'F'IP�1, Su='r oP E3uitUtNG OC"IT' ��
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL �- -` / -` --'--'—
DESCRIPTION LOT NO OWNER
_ MAIL r
_BLOCKTRACT > ,,. _ADD.RES.
NO.OF BLDGS. i a
SIZE OF LO'f °r,I,,°n ' NO1V ON LCT CITY. �` �'"1'EL. NO ,.
USE OF „�::+� -- '— - DISTRICTN GR -P MAPBUILD9NGS _ BK PG
CONTRACTOI"t , _:. •__, ., ,-
CONNECTION DATA
ADDRESS ---------------_._.----
-..- `--
CITY TEL. NO,- --�`
--- -� - --. MANHOLE REFERENCE
.STATE LOWER
-REGISTRATION 140.. - ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
- ------- TYPE OF CONNECTION LENGTH FROM
! HOUSE SEWER CONNECTING TO ! j Y. CURB P.L.. YL.TO P,L,
PUBLIC SEWER - @ $3.500f_-- - -----
'; SEPTIC TANK,SEEPAGE PIT OR !
PITS AND/OR UR.!t(NFIEL"v (x, $:3.00; , --------.-.._--�-__ -----._
-IOVERFLOW SEEPAGE PIT,DRAINFIELD -.-�--J-.-._-_ P C..NO. ---- ---_" ----
kXTN..CESSPOOL,DRYWELL,Iv}AN_HOLEfty $2.U0 i CO, PMP. N0._- _- !OB NO. -----_-"—_-"-_
HOUSE SEWER CONNECTING TO !. j
PRIVATE DISPOSAL SYSTEM Ors) $!.ODI TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR —-- ------ _-_ - -- ---
.F WORK TO HOUSE SEWER ?-+f�i; a i' STATE ENCROACHMENT
--- „�• C� t.00 • PERMIT NO.
l>E.P_A,R OP.ABANDc�P.,�iooS.E I + ! INDUSTRIAL
SEWER SYSTEM'"-- r T 1,00 ' y -- ?;PASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PI;IIn�IT � I —1 i oo _ ---- --_' --
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 9 �
I HAVE AT THIS DATE A CONTRACT WITH THE HERE NAMED CON. _ APPROVALS DATE IINSPECTOR'S SIC NATURE
TRACTOR TO CONNECT '{HE ABOVE DESCR13ED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 1J-.__ CONNECT ADDITIONAL - _ .-_---
OWNER OR BUILDING OR WORK
OWNERS --------------
_�.._�_____—�_�_— SEPTIC TANK,SEEP,PITS) 1 ADDRESS—____ ANVOOR DRAINFIEL.D._
AT - "-"-}--��_—^`'. —CcSSPfl OL.{� DRYNELL L,
I HEREBY ACKNOVi LEDGh THAT l HAVE READ THIS APPLICATION I
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE AWS REGULATING ALTER,REPAIR.SEWER OR i
PLUMBING AND SEWERS. SEW A.Gh DISPOSA L.SYSTEM
PERUEGISTERED AND�'OR
---
1 HEREBY CERTIFY THAT i AM -- --_--- ---- -""-
L.iCENSED AS REGUIR' ,CY LOS JG LE5,/C UNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA -0R TH. A.F.9 --! ' L GA - NER OF I'3E AQ6VE AQANDON HOUSE SEW ER
DESCRIBED RESIDE I ROP Y,. BACKFILL SEPTIC TANKS❑
SIGNATURE '. SEEP.Pit(S) V CESSPOOLS ----------i---'---—,---
OF PERMITTEE -- -- -- - ---- - — i E..
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. 'WOOD,CHIEF PLBG, INSPECTOR
ASH
dS •F'"" " _.:3 tit VIP, 4 10 A
3.00 t!
6420
hI&H-663 P2.34 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL Ri NEAREST
��, CROSS ST
LEGAL
DESCRIPTION LOT NO. OWNER
-
-- - -
BLOCK TRACT ' MAL -
' S ADDRESS -
NO. OF BLOCS.
SIZE OF LOT NOIV O'1 LOT CITY TEL. NO ,- r'", :j
USE OF
BUILDINGS DISTRICT NO, ! GROUP YAP
iBK PC'
CONTRA C70$.... .0 .,r' a t f r _
ADDRESS', s CONNECTION DATA
1
CITY .,.., i - { -
TEL. .�',�'" c .� STATION �- ' DEPTH I .
" C_+"f STATE d MAI;RO'CE"REFERENCE
REGISTRATION NO. %- r,' COUNTY ,:..� TIPPER LOWER.
TYPE GF.�C'0-1dNEC71UN—' LENGTH:FROM � .----
No, j DESCRIPTION OF WORK FE£ ;_____ ,use P.L, -44. TO P L. !_
HOUSE SEWER CON'VEC ItiG 'Iv � J I -,� - °`""�Y
v? PUBLICSEWER �! 3.5q
HOUSE
�{ HOUSE SEWER CONNECTING TO _ ^^
PRIVATE DISPOSAL SYSTEM I.00 _ -
CONNECT ADDITIONAL BLDG. OR µ -� NOMPJOB
CO. I . -:�.� _ :�
WORK TO HOUSE SEWER i.OD NO _
I ALTER OR REPAIR EXISTING i� >` '+
�[WER.OR DISPOSAL SYSTEM,
_ 11,00 I { TRUNK PERMIT NO, RGAD PEFcIA!'T NO.
°/,7
DISCONNECT AND RBANDON SEWER STATE ENCROACHIdENT -
AND/OAR DISPOSAL SYSTEM1.00 I PERMI'I`•RLO.
SEPTIC TANK SEEPAGE PIT OR - -
I PITS'AND/OR DRAiNF1ELD T 2.00 I I INDUSTRIAL -
-. WASTE APPROVAL
CESSPOOL DRYI<;ELL
SPF�IAL COniDiTi0N5 ONLY 2.04 ( ��- -CHARGES
PERMIT' CONNECTION CHARGE FEE
OWNERS ( I 00_
AUTHOR TOTAL FEE P,EIK9lJRSEMENT FEE
I HAVE THIS DATE. CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCR�EO EXISTING DWELLING
TO THE PUBLIC SI",VER ��
NEW HOUSE SEWER
SIGNED THIS. DAY OF
OWNER OR x CONNECT ADDITIONAL
OWNERS AGLPeT .. �'L=- C t r __BUILDING OR Y'ORIi _
--..- , SEPTIC TANK, SEEP,PIT(S)
AND/CR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL O
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
IHEREBY CERTiFFY THAT I Aid 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 __.___--_—..�._.v.__-_. -.._..v.:.-...............
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) 0 CESSPOOLS Ll'-
SIGNATURE , - -
GF PERMITTEE'
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
BY By
DEPUTY DEPUTY
BY BY
C DEPUTY DEPUTY