HomeMy Public PortalAbout4835 RIO HONDO AVE_Sewer__ -E808 3-61
r6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B U I L D ISN G -1
DRE S —/ ,.,
JOHN A, LAMRIE, County Engineer D 3
WILLIAM A. JENSEN, Sup'i of Building
LOCALITY
NEAREST
FOR APPLICANT TO M IN r_CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACTADDRESS
NO,OF BLDGS.
SIZE OF LOT I,4OW ON LOT ...... CITY TEL. NO.
USE OF I
BUILDINGS DiSTRICT NO GRO MAP PRO; BY
KPG
CONTRACTOR
/
ADDRESS CONNECTION DATA
CITYf ate, Y4TET.,N0. STATION DEPTH
REGISTRATION NO. H COUNTY MANHOLE REFERENCE --KP—PER
LOWER
140. 1 DESCRIPTION OF RS FEE
HOUSE SEWER CONNECTING TO
— PUBLIC SEWER $3.00 TYPE OF CONNECTINLENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
--EX N..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 Co.fmp.NO, JOB NO, 0
L)
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT 0
SEWER OR DISPOSAL SYSTEM $1.00
PERMIT NO.
L)
-- INDUSTRIAL Uj
WASTE APPROVAL CLU)
CHARGES z
OWNES J/PEBMIT 2 00 CONNECTION CHARGE FEE
AUTHOMAnON I TOTAL FEE —F71-1 el REIMBURSEMENT FEE
I HAVE AT 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(S)
AND/OR DRAINFIELD
HEREAT ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND
D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL [3
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
U B N G AND COUNTY
C
PLUMBING
LUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPDSALSYSTE14
I_ HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
I,
LF_CENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE S
L
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _EWER
It__ :
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS 0
SIGNATURE
E CESSPOOLS C3
IGNATURE
OFp I TTE
PER T r
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAJ-.-FENGI NEER
a � r
ABG 21" APPLICATION FOR PERMIT `,
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL'
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Enggineer ADDRESS ` l 2r
WILLIAM A. JENSEN, Sup't of Building ;.00ALFTY - 4
NEAREST
AOR APPLICANT TO FILL IN
CROSS ST. a
DESCRIGPTtON LOT N0 '1 E' ✓ % :t `yy OWNER ,
�t3s 7 u_
BLOCK TRACT 1 MAIL
Z ADDRESS
NO.OF BLDGS.
SIZE OF LOT �' NOW ON LOT CITY TEL. NO
USE OF -
BUILDINGS L`'.--_� j «>`r DISTRICT GROUP MAP PROCES -P,2Y
BK Pid _ I J y
CONTRACTOR;
ADDRESS _ -' - CONNECTION DATA.
STATION
i ." DEPTH
CITY � c�.�` .^ TEL.N0. �a �° �+ .i
!` /' f9s STATE MANHOLE REFERENCE
REGISTRATION 140• U COUNTY ✓7 „+, IafyWER
NO. 1 DESCRIPTrO OF WoK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE;PIT OR Y. CURB P L b M.L.TO P.L.
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT,DRAFNFIELD �f, � - ` ✓'�
EXTN,.CESSPOOL.DRYWELL @ 52.00 r�� �` /` d
HOUSE SEWER CONNECTING TO P,C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO. U
CONNECT ADDITIONAL BLDG.OR /;- TRUNK PERMIT NO. ROAD PERMIT NO. 9x
WORK TO HOUSE SEWER $1.00 O
ALTER,REPAIR OR ABANDON HOUSE. STATE ENCROACHMENT 0
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT NO. I,)
INDUSTRIALW
WA5TEAPPRf}VAL'J': '✓' ., d
Y i - .:4 .,�a y, �'�j3 f ! aL.� ="✓E..� {e'' - ;"of R{i�S t _ ,�.-i L l r Z
O WNEWS �EIdIKIT ni3,,, s ,2 00 CONNECTION CHARGE
AUTHORIZATION I TOTAL FEE I '- REIMBURSEMENT FEE /f
DAA CONTRACT WITH THE HEREINAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DATE INSPECTOR'S 51GNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF. 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT. BUILDING OR WORK
ADDRESSS€PTIC TANK,SEEP.PIT( )
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION ANDJOR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL L7 DRYWEL L]
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER R
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYST N
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWE
CALIFORNIA OR THAT 1 AM THE LEGAL OWN OF THE ABOVE I
BACKFILL SEPTIC TANKS []
DESCRIBED RESIDFMIIAL PROPERTY 1-7 BACKFILL
❑ CE OLS
SIGNATURE
OF PERMIT TE % `. � . .a.,- `._.... ; .:r
' VALIDATION ROBERT A. WOOD
CASH SUPERVISING MECHANICAL ENGINEER
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