HomeMy Public PortalAbout4825 RIO HONDO AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING S r
ADDRESS — Eyf_ a' a
FOR APPLICANT TO FILL IN LOCALITY `
BUILDING NEAREST
ADDRESS_ CROSS_ CROSS ST.
LOCALITY DISTRICT NO.i_ SERIAL NO, PERMIT NO.
NEAREST --- —.�__ S
CROSS ST. -
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS _ USE ZONE OCCUPANCY BK MAP PG
CITY TELAO.
CONTRACTOR
------ CO.IMP.NO.
ADDRESS
JOB N0. .
CITY TELAO.
TRUNK PERMIT NO.
STATE
REGISTRATION N0. [�J COUNTY ROAD PERMIT N0. X
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
—
SIZE OF LOT N0.9F BLDGS. WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS - CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
s HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT N0. I DATE �BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER 911 REPAIR EXISTING NO- DATE 18Y
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AMD/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER
-LOWC.,
TYPE OF CONNECTIONLENGTH FROM
CORR P.L. M.L.TO P.L.
OWNERS PERMIT # I 00
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
"�
SIGNED THIS_-._ �42...�AY OF.- - ::... AI_.._... NEW HOUSE SEWER
OWNER OR AF C ,r CONNECT ADDITIONAL
OWNERS AGENT ` ..... � sr BUILDING OR WORK
•_, .. . _ -
ADDRESS............. .....----.....--....-...--.-.-._.-.----.-----..- SEPTIC TANK.SEEP.PIT(S)
--•---------•••-•••-•- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL[-] DRYWELL I]
CATION AND STATE,THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.P17(S)E] CESSPOOLS E] j
IOF PERMITTEE..... - ,.. -------: ------ I
i6.36i`31i tii;<> 1;53
6ABA2D APPLICATION FOR PERMIT.
E608 8-84-
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS J 1
JOHN A, LAMSIE, County Eaginees
CASSATr D. GRIF`F'IN, Supt o£ Building LOCALITY i2 7 �:
NEAREST
FOR APPLICANT TO FILL IN caoss sr.
LEGALw._.1
DESCRIPTION LOT N0. '� ,( �� OWNER
BLOCK TRACTs` MAIL
ADDRESS `
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY ZnZIMe dl Z' TEL. NO. &7c`` t
USE OF - cY
BUILDINGS ' >`c DISTRICT N0. GROU MAP PROCESSED BY
I ) PG I
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL.NO. STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. COUNTY LOWER
NO. 1 DESCRIPTION OF WORK FEE ' r
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Gam' $3,00 TYPE Of CONNECTION` LENG H FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB i P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL.DRYWELL $2.00
HOUSE SEWER CONNECTING TO - P.C.NO.
PRIVATE DISPOSAL SYSTEM @ S1,00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG,OR
ORK TO HOUSE SEWER @...$x1,00 TRUNK PERMIT N0. ROAD PERMIT N0.
W
Al TER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
.SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
��;''� CHARG
OWNER'S PERMIT 2 OO �C(fNF1ECCIlaN ekAR�i FEE - _
AUTHORIZATION TOTAL FEE I
J IE' REIMBURSEMENT;tE
I HAVEAT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE 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(5)
AND/OR DRAINFIELD
IH
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 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 REGI TERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNT AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM, $1E .EGAL 0�1iN OF THE ABOVE
DESCRIBED RE�DENTIAL PRO E TY' � ' BACKFILLSEPTIC TANKS ❑
SIGNATURE SEEP<PIT(S) CESSPOOLS
OF PERMITTE
,'—"IVALIDATION ROBERT A. WOOD
6 CIC K.0• CASH SUPERVISING MECHANICAL ENGINEER
s