HomeMy Public PortalAbout6122 RENO AVE_Sewer__ E8085-65
6A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
R E-1
'U7
JOHN A. IANIHIF. County Engineer ADDRESS
COLEMAN A Sup't. ,f Building
LOCAL
L'_ +a.L
T lum/I
_OCALITY
A
NEAREST
F.ROSS ST.
FOR APPLICANT TO FILL IN
LEGAL
RE5CRlPTION LOT No. OWNER
- -ov OAIV4
MAILFS5
BLOCK TRACT 10 AD D R le F
NO. OF ELL GS,
SIZE OF LOT ;;plNOW ON L07 CITY,4&Q TEL. NO.45�Vj
USE7
BUILDINGS DISTRICT NO, GROUPI MAP I PROCESSED 11
BK. PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY STATION
LZN DEPTH
LICENSE PPER
No CLASS MANHOLE REFERENCE
NO. 1 DESCRIPTION OF WORK W FEE TYPE OF C NZ�[ON LENGTH FROM
H OUSE SE WER*CO-NNE _CTING T 0 Y �6R P.L. M.L.TO P.L.
PUBI IC SEWER
$ 5.O0 ------
C-T
S E P T I C *r X-PoK,SEEPAGE� _ _F Tf TOR XL
PITS AND OR DRAINFIELD $I ci.0 CO, IMP.NO.�_L 0
H 0 U 5 E SFW R CON N_ECT_M_GT TO TRUNK PERMIT NO. ROAD PERMIT NO. u
[,PRIVATE DISPOSAL SYSTEM r- 3.00 ix
CT __E_Nj---RECORD. N —DATE
WORK TO HOUSE SE*E-P- $ 3.00: EASEMENT D STIR.NO, 0
A-LYE-R-,"R �-AIR—OReA
SEWER OR DISP 0 5,LffjA WN ------—————-
SYSTF
$ 3.00 uj
HWY.OR ST.WIDENING
_ -
T _T N_CESSPOOL. MAN4CLE 5.00 5ATEENCROACHMENT z
I PERCOLATION TEST $ 5.OG r PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWL4M'S PERMIT 2 00 _—
AUTHORIZATION L.
CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
T
TRACTOR TO CONNECT THE ABOVEDESCRIBED EXISTING DWELLING —_ --- —
To THE PUBLIC
SEW APPROVALS DATE INSPECT--'.SIGNATURE
THIS TI. AY OF_\7_,oelA_,-o'
`----
OWNEROR vc _nAW HOUSE SE%IVER __
OWNERS AGENT
4 ECT ADDITIONAL
BUILDING OR WORK
_ADDRESS._.__
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
PLU MIS ING AND SEWERS. CESSPOOL [I 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
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
DISCONNECT PLUG AND
RESIDE_ IN, THE: ABOVE DESCRI�ED RESIDE IAL TY. ABANDON HOUSE SEWER
SIGNATURE �f
PER EIAC SEPTIC TANK
OF PERMITTEE KFILL E
M
SEPTIC
PITS) 0 crss5p000LS Eli
VALIDATION
M,0. CASH
L&O 2 6 2 4%:aL MN 16 1 C' D 5.C) 0—
F808 5-6 6A642D 5 APPLICATION FORSPERMITCOUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION 87nING -
I-D I
JOHN A. LANIPIE, County Enginer ADDRESS
COLEMAN W. IFNKINS. Supt.. of Building
LOC A Lil Y t)le City
'R_
N F-
E 1-1 R E s T
CROSS ST
FOR APPLICANT TO FILL IN
LEGAL
-
--
DESCRIPTION _-_-LOT_NOS
N�E wt
MAIL ----
BLOCK TRACT ADDRESS
20 Birchcreft
NO, OF SLOGS.
SIZE OF LOT NOW ON LOT CIT TEL. IN
USE OF ------- rt- 0.
BUILDINGS
---
-
DISTRICT NO. GR up
MAP
PROCESSED BY
SK PG
CONTRACTOR
- - squre DeAlSwer Sorvic F
ADDRESS Maxsox Rd.
CONNECTION-DATA
CITY N-.4 STATION DEPTH
LIGE NSE LICENSE
NO, CLASS MANHOLE REFERENCE
O�F
ER
-12 M-7-0- LrOWER
DESCRIPTION WORK
MOUSE SEN c6NNEcfiNnTo-------- TYPE OF CONNECTION LENGTH
Y. CURB . . FROM
P L TO ..L
SSE ---TAN-
:�91JBLIC SEWER 00
-- s 5 00 P.C.NO.
SEEDSAGF P -------: -- --
PITS AND,OR DRAINFIELD $1 o.00 CO. IMP. NO-
JOB NO.
US-ESEWER
—
PRIVATE DISPOSAL SYSTEM $ 3.00, TRUNK PERMIT NO. - ROAD PERMIT NO.
CONNECT WAlVlii�jA—MNI� REr.jjb:7N. -RN-O
WORK TO HOUSE SEWER $ 3 AFFIDAVIT
SEWER OR DISPOSAL SYSTEM $ 3,00i
EXTN.,CESSPOOL, VAN'OLE HWY.OR ST.WIDENING
$ 5.00,
ATEENCiRoAEHS�ENT
I PERCOLATION TEST
$ 5.001 71 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
- 07/
OWNER'S
- 'e5 . .....'
W N TER'S PERMIT CHARGE -
.Z -00-
CON NECTIQ.N15HARG E:FEE
o
AUTHORIZATION TOTAL FEE 5 � 0
IHAV AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON RPAURSEMENT FEE
TRACTOR EC
RACTORT 0 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE
PUS L IC SEWER-
SIGNED THIS---DAY APPROVALS DATE I'll P.TOR'S SIGNATURE
OWNER OR
OWNERS AGENT NEW HOUSE SEWER
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
ISEPTIC TANK,SEEP,PIT(S)
HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE T A COMPLY ND/OR DRAINFIELD
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING
S ING AND SEWERS.
IRS, CESSPOOL El DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALIF ,REPAIR,SEWIER-oR----
LICENSED REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL,SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER AND INTEND TO
RESIDE IN T Il E ABOVE DESCRIBED
RFSIDCNTI PR ER'TY,
DISCONNECT PLUG AN
SIGNATURE
ABANDON HOUSE SEWER
lle� -,.a
OF PERMITTEE 1�� SA(7KFIlLSFPTIl;TANKS ❑
_F" FIT'.) El CESSPOOLS C]
VALIDATION
CK./
K M.0. CASH
3 0 6 7�8 FEB 9 1 u D