HomeMy Public PortalAbout6311 SALTER AVE_Sewer__ 7A1420
a6A��za APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL_
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION SU I LDING y
JOHN A, LAMBIE, County Engineer
ADDRESS
- .
WIUTAM A. JENSEN, Sup't of Building ">
NEARS T
FOR APPLICANT TO FILL IN RO S_4T
-
D S--R P710N LOT NO / OWNER _ e _.. _-y.•`.__________._._—__�__._
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PAAiL
y � y yJ,I,I ,s > i;.
BLOCK / -� TRAC7...G..f`F %d"LL G�J ADDRESS
No.
BLD
SIZE OF LOT NOW ON LOT CITY TEL. NO.
U5E OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
SK PG
CONTRACTOR ej �✓/ ��.L'L 6 .s / � f
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ADDRESS '9 CONNECTION DATA
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,7' / .J ST,d. / q DEPTH
1IT'f �'�:.f i"' TEL: NO. �_. w > L Y ION 8 l� ,b, 'ems '9
REGISTRATION NO. �{ � ,% � � COU MANHOLE REFERENCE J .0 UPPE�i
_ i. .i _ ; COLJ NTY .i •, f l d. .EiW-ER--
NO, DESCRIPTION OF WORK EEE TYPE OF CONNECTION LENGTH FROM � e
...-.-
HOUSE SEWER CONNECTING TO Y. .CL RS P L -, M.L 7D P L_. _-_
FURL r' v5-00S
EWER C� 5.G0 -
bTi 'TAhft R C NO
SEEPAGE PiT Or{ --__. 1
PITS AND/'(
C R DRAIN $10.00 CO.IM:F NO, JOB NO - -
HO SE SF Nf�f CONNECTING f0 _._N
PRIVATE WSPOSAL SYS' `� $e.DO. _ TRUNK PERMIT NO. -ROAD PERMIT CVOs'
-- JNNECT AO'J1i iONAL BLD<-.OR �-AFFIDAVIT WAIVER EASFMENT i RECORD.INST
WORK TO HOUSE SEWER @ $3.00 I O f
_._ _ ,.__. -
-`-
I �lERf LOW Prn E FIT-DRAiN iLLD
EXTN CES POOL.DR WEI;yP15,,C HOLF 5 00 --- -- ---_-
----- -- - HWY. RST WIDENING
i 4LIfR RF A R OR ABAN � Mi�U_E� -- -- �
ggg O
SFWE SRU P6 $3.00 ____
-__ - _.-_..� .. y -:-.. STATE NORflACH MEN.
PER.Mt NO
-_— IN pl*L _ --_ 'I_ _.-
WA " ;7
OWNERS I PERMIT --- cHARGEs
-�=acs _ ------------------ ---
.____.-.__. CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE __ - ------------�_�_--------_- _--
I HAVE AT THIS DAT=' A CONTRACT' WITH THE HEREIN NAMED CON- fftE1t+1B RS_ME NT FEE
"RAS"I'OR TO CONNECT �G IIWCLL
TO THE PUBLIEWIR APPROVALS NG
p .. E 1M1tlSF F:C'TOR 5 SIGNATURE
E ABOVE DESCRIBED EX!5TIN /
SIGNED THIS---"` DAY OF--------'--fir_ Igc�._% ------ ._---- - ---._ - - - -- ----- --- -
r- DA �
OWNER OR t NEW HOUSE SEWER.
. - _.- .-__
ADDRESS
OWNERS.4 C,F CJT--�_ ��,.�� _CONNEC—ON-N ADpI_T_IO_N AL.
BUILDING OR.WORK II
. -- __- - -_ -__
SEPTIC RANK.SEEP,PIT(S)
1 HERE(3} A, K'vOWLED F THAT I HAVE R€AD THIS APPLICATION^ ANi71C7Fi Df>ACNF CwO
AND STA.T2 THAT "IME ABOVE 1S CORRECT AND AGREE TO ('(-,,MPL,Y
W1111 ALL GC!.NTY t)RMINANcr-S AND STATE LAW„ REGLILATIN<S
PLUMBINGAND NL SEW i:RS. CESSPOOL L.1 DRYWEL.L ❑ �
I HEREBY CER71FY TP AT1 AM PROPERLY REGISTERED AND/OR -
.R ALTER,REPAIR,SEWER OR 7
t..t CENSED AS FEQUIR'F.0 BY LOS ANGLES COUNTY AND STATE. OF SEWAGE DISPOSAL SYSTEM
CAL-IFORNtA OR THAT I AM THE LEGAL OWNER OF., AND INTEND TO - _'-- ----T "-`-i"-----'
CONNECT PLUG AND I -
REStDE (N, THE ABOVE DFSCRS BED ,RESIDENT:A,G' PROPERTY. ABANDON HOUSE SEWER I
S.IGNAT�:f§tf'
OF PERMf7TFE B.ACKf`!LL SEPTIC TANKS ❑ �I
SEEP. PfT(S) CESSPOOLS �
VALIDATION ROBERT A. WOOD
CK., M.O. CASH SUPERVISING MECHANICAL ENGINEER
SEGOS 8.106 APPLICATION OR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING v
JOHN A. LANIBIE, Counter Engineer
GASSATT D, GRIFFIN, Supt of Building _LOCALITY
NEAREST '`--_._y - -
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL ➢,
DESCRIPTION LOT NO �., OWNER 'l
BLOCK �° fie* m y^ MAIL
TRACT
7 �"Z ,C�'; �t 4 S'.T � -ADDRESS
NO,OF BLOCS. f
SIZE OF LOT NOW ON LOT J CITY TET.. NO.
USE OF
9UILpINGs' DISTRICT NO. GROUP MAP PROCESSED BY
BK PG r
CONTRACTOR :s r
ADDRESS' ; t ,'i CONNECTION DATA
CITY X TEL f
NO � DEPTH
STATE MANHOLE REFERENCE .b 4' V4 - - UPPER
REGISTRATION NO. �,. - COUNTY
Na. DESCRIPTION OF WORK FEE f
HOUSE SEWER CONNECTING TO .�.f .
PUBLIC SEWER C-) $3,00 • ! �''
TYPE OF CONNEM ON LENGTH FROM j
SEPTIC TANK,SEEPAGE PIT OR YR ° P.L. M.L.TO P.L.
Y.PITS ANDIOR DRAINFIELD @ $9.00 a>
OVERFLOW SEEPAGE PIT, DRAINFIELD '
EXTN..CESSPOOL,DRYWELL Cj $2.00
HOUSE SEWER CONNECTING TO P,C.NO,
PRIVATE
KTO HOUSE SEWER @ $1.0DISPOSAL SYSTEM @ $1.00 CO.IMP,NO, ,-� _ .3OB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAR PERMIT N0,,% ,, _—`�
7
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER O Di SPpSAL Sl STEM $1,00 PERMIT NO.
INDUSTRIAL
WASTEAP �°.;/:. $"fis��
CHARGES
OWNER'S PERM $ 2 (�40� CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I�DATE�j!NSPECTOR'SSIGNATURE
TO THE PUBLIC SEWER. '
SIGNED THISDAY OF F` I9_
OWNER OR NEW HOUSE SEWER �
OWNERS AGENT r.. ,{` ` CONNECT ADDITIONAL.
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBYACKNOWLEDGE: THAT I HAVE READ THIS APPLICATION
AND STATE THAT TH- ABOVE, IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
{ HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUfREO BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT' I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL ROPERTyK BACKFILLSEPTICTANwS []
SIGNATURE ! �r SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE
VALIDATION ROBERT A. WOOD
^ CIL H.O. CASH SUPERVISING MECHANICAL ENGINEER