HomeMy Public PortalAbout6262 RENO AVE_Sewer__ Ce.
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:EI3013 5-65
6A 642 D APPLICATION FOR PERMIT'
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
J(11\ A. L2%%1RIF, Count) Fngin,cr ADDRESS
C01,F]MAN IX JENKINS, Sup't. of Building
LOCALITY r;
NEAREST
FOR APPLICANT TO FILL IN ST.
--- ---
DESCRIPTION—_
LOT NO, S' 6 OWNER ("r.
MAIL
BLOCK _____TRACT ADDRESS
NO OF BL GS.
SIZE O'"_,L. N CITY 5' TEL. NO. CO' >
T 0 LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAPp ROCESSED BY
BK FG
CONTRACTOR
-
[ADDRESS "f v CONNECTION DATA
CITY ✓ TEL. NO,
STATION DEPTH
LICENSE LICENSE ------- ------ UPPER
No. CLASS MANHOLE REFERENCE LOWER
FEE TYPE OF CONNECTLENGTH FROM
NO HPTI 6 I�1��(�R K ION OM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER $ 15-00
SEPTIC TA --- I — P.C.NO. CL
PITS AND OR DRAINFIELDCO.IMP.NO. JOB NO.
$7 0.001 — ---.. . 0
TRUNK PERMIT NO. ROAD PERMIT NO.
— R SEWER CONNFCT7N' 776-------—�-------
HOUSE 4PRIVATE DISPOSAL. SYSTEM $ 3.00�
O Ar WAIVER A�SEMENT R.NO. DATE
CONNECT ADD11IONAL BLDG. OR RECORD.INST
WORK TO HOUSE SEWER $ 3-01
p 4-8 4WO a—N 0�u fS
D!SPOSAL SYSTEM 3,00 uj
HWY. OR ST.WIDENING CL
EXTN.,CE55PO0L, MANHOLE 5.001 —ATE ENCROACHMENT z
PERCOLATION TEST PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT 2 00
-+- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I '� c/,-::
*1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO C0NECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC
SEWER, APPROVALS DATE I NSPECT:)R'S SIGNATURE
SIGNED THIS DAY 0
OWNER OR NEW HOUSE SEWER
OWNERS AGENT A CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
111TIl TANK,SEEP,PIT(S)
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR D�RAINFIFLD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING
ING AND SEWERS.
RS. 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-ITATE OF SEWAGE DISPOSAL SYSTEM
E
CALIFORNIA 0 THAT I AM THE LEGAL OWNER OF."AN ;Tplll TO DI SCONN5CT PLUG AND
RESIDE IN, THE ABOVE DESGJRtBEO RESIDENTIAL T'AL ..
ABANDON HOUSE SEWER
SIGNATURE
0 BACKFILL .ITT.TANKS
OF PERM �Sj
SEEP,PIT CESSPOOLS
CCK. j) Id.O� CA.-
' 7 4
u
a-
i titai i'LE CITY
;E308 5-65
76A 5420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
&,DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LANIBIP: County Engineer ADDRESS 6a2-
COIYNIAN A. jF:NKl",S,Sup't.of Building JjJ
LOCALITY
N RU
A"
g
0
BUILDING
HESS
LOCALITY
NEAREST
S BT,
_R_
FOR APPLICANT TO FILL IN
-e.
OWNER }
OWNER Murray Roche
LEGAL LOT NO. 6t-) _j
DESCRIPTION MAIL
ADDRESS
BLOCK TRACT
SIZE OF LOT 61) NO OF BLDGS. C R. Pail NO.
U.�C) LOT— TI TEL.
USE OF DISTRICT NO, GROUP MAP PROCESSED BY
BUILDINGS BK PG
/6
_Square De_aL_S0_W0_r__S9rTice
CONTRACTOR TJ
.CG___
SS
CONNECTION DATA
2933
STAT DEPTH
CITY
I TEL. NO. 4-2020--..
LICENSE LICENSE MANHOLE REFERENCE v`ti-:5 —LOWER
NO. 12.$$7Q__._C_lASl C-162
- __-6-E- — LENGTH FROM
N-o TYPE OF CONNECTION
HOUSE SEWER CONNECTING TO
SCRIPTION OF WORK FEE CURB___
M.L.TO P.L.
RB P.C.NO >_
'U'L IC SEWER $ 5.00 00 m
Co.IMP.NO. JOB NO 9�3
IT AND/OR DRAINFIELD $
IL
USE SEWER CONNECTING TO
TRUNK PERMIT NO. ROAD PERMIT NO.
z
PRIVATE DISPOSAL SYSTEM $ 3.00
EASEMENT
NSTR,_— --r- DATE 0
-
CONNECT A]DDFTjF"L_BLOG. OR NO,,
WORK TO HOUSE SEWER 3,001
SEWER OR DISPOSAL SYSTEM $ 3.001HWY.OR ST.WIDENING CL
_in7 F E_0w=_"wG_F_pTlr__17qwmrTEl:U_____ ti)
EXT N.,CESSPOOL. MANHOLE $ )0 ENCTROAC14MENT
Z
I F;iRCOLATION TEST a $ 5 000
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
—----------------- CHARGES
OWNER'S PERMIT s —z'' 00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 100
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
E
T RACT 0 R TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _kPPACdvlus DATE INSPECTOR'ir'iiGNATURE
TO THE PUBLIC SEWER.
SI GN ED THIS_DAY OF_I 9—
NE HOUSE SEWER
OWNER OR
OWNERS AGENT--- CONNECT ADDITIONAL
BUILDING
__W G OR WORK
ADDRESS.__-._------------ F;IT(S)
SEPTIC TANK.SEEP.
I HEREBY ACKNOWLEDGE THAT I HAVE REAL) THIS APPLICATION AND/OR DRAINFIELD
- tDATE 'NSPECTO'4Wlr'S_IGNA
APPROVALS.
V
SEWER
T I RNA L
_I, PIT S'
SEEP.
N 0 STATE THAT THE ABOVE IS CO RRECT AND AGREE TO COMPLY
---
WITH
j TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING DRYW
CESSPOOL 0 DRYW ELL ❑
PLUMBING AND SEWERS.
IHEREBY 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
A OR THAT I AM THE LEGAL OWNER OF,A�10 INTEND To AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL ABANDON HOUSE SEWER
SIGNATUREL
n CESSPOOLS
IT(S)
❑
OF PERM TTEE BACKFILL SEPTIC TANKS
OF PERMITTEE
❑
Aj VALIDATION
j_CK M.0 CASH
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