HomeMy Public PortalAbout6246 RENO AVE_Sewer__ CF,1308 2/70
76A 642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL L
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
U I LD 1 N G
U toj A v
JOHN A. LAMBIE, COUNTY ENGINEER FADDRESS
COLEMAN W. JENKINS, SUPT. OF BUILDING
LOCALITY
T-
NEA
't� T.
R APPLICANT TO FILL IN CROSSST
(PRINT OR TYPE ONLY)
DEISC_RIPIIRP� LOT NO. OWNER
MAIL
BLOCK ADDRESS t4
RACT
e OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL, NO,
U DISTRICT NO. I CLASS MAP FROCES-1ED BY
S� F
BUILDINGS SK
//17
CONT R_�C�TOIR
ADDRESS CONNECTION DATA
CITY TEL. NO. STATION DEPTH
_ UPPER
LICENSE NO. OW R
STATE LtC
CLASS MANHOLE REFr
0. DESCRIPTION OF WORK FEE TYPE OF CONNECTIO TH FROM
0 Y.________CURB 'L
�L.TO F.L
P11 toi IU3 LsiE,SEWER
RF- P.C.NO.
R
EIS.E EFE� "CC I
E 6 CC UR. T D L
, GKPTFC ANK.SEEPAGE PIT OR
PITS AND/OP DRAHA51ELD C-0,IMP. NO,.-.------ OBNO.
TRU14K PERMIT NO-- ROAD MIT NO.
_<110
PRIVATE DISPOSAL SYS TEM $3.00
P
W&,V EME-HT
A-FF I DAVI T�j-W I CAS INRTR. I A E
____
WORK_TO HOU E SEWER 3.00
OVER F LOVA'SEEPAG Ii Pl-�-DRAINFIELO
_____E-XTN.CESSFtOOL.C)RYWEL.L.MANHOE(T 35�- D
N
ABANDON HOUSE HWY.0 ST.WIDENING 0
"AL 5Y TEM @ $3,00
STATE
PERM"No. LIJ
INDUSTRIAL
WASTE APPROVAL z
OWNER'S PERMIT
CONIII1.11ON CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A REIMBURSEMENT FEE
M
RAcr WITH THE HEREIN NAMED CON- RE
CON IB
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TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
LS
To THE PUBLIC SEWER. APPROVALS I DATE i INSPECTOR'S SIGNATURE
SIGNED THIS `DAY
OWNER OR r NEW HOUSE SEWER
OWNERS AGENT---- CONNECT ADDITIONAL
BUILDING OR WORK
ADDRED
R
S-S
sEwnc'TANK.SEEP,PIT dS)
I HFRERY ACKN0A'LFDGE THAT I HAVE READ THIS APPLICATION
I RE' AND/OR GRAINFIELD
AND STATE THAT THE ABOVF IS CORRECT AND AGREE 0 COMPLY
'AT
WITH. AL�L COUNTY ORDINANCES AND STATE LAWS REGULATING
IT
"_E� E 'LL
FILUM IN G AND SEWERS. CESSPOOL 0 DRYWE
I HEREBY CERTIFY THAT I AM PROPERLY REGISTER A /OR ALTS R,REPAIR,SEWER OR
'ED BY fSPOSAL SYSTEM
;r
IJCI�NSE D A A TA E OF SEWAGE 0
TE D I DISCONNECT PLUG AND
SIDE IN. 'HE rrS RTY.
ABANDON HOUSE SEWER
ICE.
N P"I I S p
CA�.IWOHN A T D iN
A
LRE 10 A __E DES
SIG T".
SIGNATURE
., PER, BACKFILL SEPTIC TANKS
OF PFRMrTTrE SEEP PIT(s) ❑ CESSPOOLS _F]'
�LIDATIGN JACK R. ALLEN
CK. M.0 CASH SUPERVISING MECHANICAL ENGINEER
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'A64217 10_6'
6A 64APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES I SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER 11
BUILDING AND SAFETY DIVISION B:J:l_C:N
'01-IN ef, L?4 %QIP; County Engineer -------
WiILLIAM A. JENSEN, xup't of Building -
LOCAL. f' /
NEA E
FOR d'iS .,IPANT Y O FILL I1�. ='ROSS. :.f - - -L
r v
tw
R,PT!0N C?W Nc:R -- `
MAIL.
@;i„!fir„Fi 'r RA<':1ADU FcEE:S '--
- — - ---- —
IIIQ or SLOGS
SleIE t7F - IV%)W ON i.C'' CITY TEL, NO.
BU U
ILDtN 5 t DSSTRiCT NO. GROUP MAP PQ ESS !}'Y
sJ— ..P ✓ f
C J NT RA C 0 F�._/ t �Y`,3r-z — .r 1'..�- -'-• J `-ef' Y �. Y�
A .>K-” CONNECTION DATA
5LP, NO-
MANHOLE
STATION - b�' L"1,R"y V; Ira'DcPT':l.
:4
REFERENCE
RCr L, RAT c N.. NQ _ i C PS1"✓ ._. sw LOWSR-
f,io r O CRIP fJ;�t OF WORK f 7Xr o t - ZISJION � �NGrr,F€0'A „� � d�
i,Hf` rI WEER CONNECTING Er!IiV_G TO ( Y. eURk3 P.L NL, SU P.L.
P11 LI SEWER
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T
F li Tt K SEEPAf E P�•i
uR P C NeV
CO, MP Jc7. 'I - JCZB 14 L7
FI ^.A OR DNAs.NFIF to �, o6t3 —
H'OU 5 E S E W 3 C3NN I G C � t p
TRUNK PERM[T ktQ ROAD 3'EiY�*YT N0. j
P AT�. S OSA L S, 7E s--3.t Ili / F -ffi,
G4FRs-G7 CDIT[c'J Aldi E3_f?G 4? AE-Y IuAYI. I WAIVER EASe'N:E14T RECORD, !N'"Y4 NO GA'CF,
7 VY<€ � INS
TR.
K TU'h -9E S 'YE, CN) $3
L�..W SEEPAGE PIT.L3RAINF ..LU
I
CE P�fY 4,P'RYW L L.S�9.hEHC:LE L $5-.vtJ
_._ _ _.. _-1HVJY..OR 5 VV!E1rvIN:G
ALTER,R f-AaR OR'ABYri12,OPd HOUSE '
SEWER GP O[SPOSA SYSTEM CY 53.00 _. 0
-- ' --,- _-. .---__ -,-- sTare ENCRGAENCROACHMENT1 PERtn€r NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
_.._ _-_ CONNECTION CHARGE FEE
r
�,U`TC)IIIZP�TIO9.�TAL SEE
HEREIN NAMED O RE!-M BURSEMENT FEE i HAVE AT Trtd; DAT'€. A CONTRACT WT'Si "r'`"' '� t' CON- _._._.. __.,
QAC fa1R TO CONNECT L ABOVE. i CRi6'Ff0 I T
__-.APPROVALS
' FXdNG DW LL hG 't
TO 7' IE UBLI EIV_F:j, ` � DATE 1 INSPECTOR'S SIGNATURE
IGNED THIS "7�,..Y,OF'
..
OWNER C7R •_'. / " �., F. ,� /C
NEW}iid;E SEWEROWNERS",GEN -
_._
-.v '�-” —">- - Cs tdN ECT AOL TIONAs
BUILDING OR W0RK
— - - - -- - - GE^''CYc:Tifar :yer- Prr 6s}
I
r+,F PbY ACKNOWI-POCK THAT P AV2 RLfAO THIS AFi+L1.ATI.ON -
ANr}/QR ORA1 i i'-I LD i
A N.0 STATE IHAT THE ABOVE IS CORRL:C7 AND AGREE TO COMPLY
WITH ALL C O N Y ORDINANCES AND ST ATE L AWS REGULATING
PI I.l,M a ING ANG E:Rs CESSPOOL Ej DRYWELL R
i THEREBY CERr,Er ..,as A,- i AM PROPERLY REG51STERED AND/OR ALTER.REPAIR,SEWER OR
L!CENSE:£i AS REQUIR€O i:Y- t.,CS ANGLES COUNTY AND STATE OF SEWAGE OfSPOSAL.SYSTEM.
c'kt_.ITORNIA ON' THAT I,k'M THE LEGAL ti�VVNE'R OF, ANI] INTEND TO
R ABANDON HOUSE EWER
51 OF IN, 71ti lBOVj�' bESf HI'3•yO RESIDENTIAL LF+�FPE R7 Y. 5
SIG'NATt'RE
'„r-•F BACKFILL SEPTIC TANKS `I
'` SELF,PIT tS) El L.ESSPOOLS
VALIDATICT--,_R, ROBERT A. WOOD
CK. M.o. CASHSUPF.jRVISlPdG MECH^�LAICAL. E�+tGNEER
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