HomeMy Public PortalAbout5041 SANTA ANITA AVE_Sewer__ 18A6dg° APPLICATION FOR PERMIT. 1
's&E.683 19.55
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER -ADDRESS
J CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. _
LEGaL ^' -_
_DESCRIPTION LOT N0. �! MAIL OWNER
,y E.�
BLOCK TRACT P � _,ADDRESS�.,,y�t�•j .e5;', a ,,
SNO
OF BLDG5.
IZE OF LOT .�' rr NpW ON LOT CITY TEL, N0.
USE OF �- DISTRICT NO. GROUP MAP
P 6
CONTRACTOR
ADDRESS r —__—_ CONNECTION DATA
-- —`---
CITY TEL. NO. STATION DEPTH
_.-._. J' UPPER
------ -- —..-- MANHOLE REFERENCE
❑ STATE _ - -- LOWER
REGISTRATION NO. ❑ COUNTY
NO. ! DESCRIPTION Of WORK FEE
HOUSE SEWER CUNNECT7NG 70 �- i__ Y TYPE OF CONNECTIO. LENG�FROM
PUBLIC SEWER CURB_` MTO P.L_ —.---
SEPTICTANK,SEEPAGE PIT OR —
PITS AND.'OR DRAINFIELD _�a $3.00y
OVERFLOW SEEPAGE PIT,DRAINFIELD P C NO
r CO. IMP NO _RSA.
NO
- 1 EX N - EaSP00L DRYW ELL M N}fOLE C� $-� OU
— I HOUSE SEWER CONNECTING T ---. —_.`—
PRIVATE DISPOSAL SYSTEM _(tt $.f.00 TRUNK PERMIT N0. ROAD 'KNIT NO.
CONNECT ADDITIONAL BLDG.OR ` >
WORK TO HOUSE SEVIER a STATE ENCROkCHMENT _
--- -- ---- $i.6D � �, _ PERMIT N0.
ALTER,REPAIR OR ABANDON HODS iINDUSTRIAL
_-- - � �-- — -- ----�—�—_–
SEWER OR DISPOSAL SYSTEM L $S.UU INDUS RIAL
� WASTE APPROVAL
- CHARGES
i
CONNECTION CHARGE FEE.
OWNER'S PERMIT _---- ---�`�_,_�_
--- ------I i off- REIMBURSEMENT FEEy,__- .4 (� ✓^I
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE DATE tT 'ECTOR"SSiG_NATURE-
TRACTOR TU CONNECT THE ABOVE DE'SCRtBED EXISTING DWELLING �.
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED TFi-IS _ .. DAYCONNECT- --- --- --
; "---- -- - _---
Ot4�NF OR '3 '�•=� BUILDING OR WORK
OYJNF AGENT �'� "_ �- -s„_.�
SEPTIC TANK,SEEP,PIT(Si
ADDRESS ' __ _.- 2f'-�L- '"'�-f'' ,.` - AND/OR DRAINFIELD
i HEREBY .ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION r
CESSPOOL[J DRY YELL[1
AND STATE THAT THE ABOVE I$ CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR '
PLUMPING AND SEWERS. SEWAGE DISPOSAL SYSTEM
HEREBY CLRTfEY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND i
LICENSED aS REQUIRED BY LOS ANGELES COUNTY AND STATE. OF ABANDON HOUSE SEW ER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ------ ---- --------
-DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
' ' f
SIGNATURE .' •a: '1 SEEP. PIT(S) EE-SPDOL5 I
OF PERMITTEE E- 2
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATI91v
R BERT A. WOOD, CHIEF PLRG. INSPECTOR
CK. M.0. +CASH� y
76RE-66 APPLICATION FOR PERMIT
1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAP/IBIE,COUNTY ENGINEER ADDRESS__ 6521-1 �� ���� �_y
CASSATT D. GRIFFIN, SUPT OF BUILMNG -LOCALITY
N EAR EST
FOR APPLICANT TO FILL IN c�o55 9T, ��>:
— ----
LEGAL. - I
DESCRIPTION LOT NO. .-.. ..�.--- OWNER
MAIL
BLOCK TRACT `✓ "'a ADDRESS
hG OF BLDGS, J L
CITE TEL., N0.
SIZE OF LOi h01, Ott LOT Z2
USE OF
BUILDINGS >Y"� � .- °�e=y`�ti�, „ -_ DISTRICT NO. 1 GROUP MAP
PG
ACTOR BIC
CONTRACTOR
—
ADCONKE&ION DATA
YVEL.r.. ,� r� ,,+', STATION_ $` DEPTH �"
CIT ,. N0. ��,+�'. MANHOLE REFEREN E T-'':�_- '`Ui^PEI•t'"
STATE
.REG;STRATION NO. -A-,
--- - _.. --- - ---- -,,
No. DkS6RIPTION OF WORK FEE --
...- - ____ _ __- __._ ,-"'-e,, 1 E,OF CONNECTION LENGTH FROM
HOUSE SEd ER CONNECTING TG
- '- TYPE,
! PUBLIC SEWER _ @ �S.aO -+'' �'= CURB.....__ _P.L. M.L.TO P.L.
� EP�'IC''fANK,SEEPAGE PIT OR�--- .. __-.- _---------
!PITS AND/CR DRAINFiELD Cr1 $3.0+3 --
OVERFLOW SEEPAGE PIT DRA NFIELD � P C NO.
j. EXTN ,CE SPOOL,DRYWELL,YANnOLE r $2..00 I CO. IMP, NO. JOB NO.
1 HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM rr $1.00 i - TRUNK PERMIT NO. f OX6 PERMIT NO
CONNECT ADDITIONAL DLDG OR STATE ENCROACHMENT
'4t)RK Y4 HOUSE SEWER fir '9.0p _PERMIT NO,. ms,
ALTER,REPAIR OR ABANDON HOUSE -- - a,
INDUSTRIAL -_f^
SFWER OR DISPOS.LSYSTEMI 1.00._ ! L ._ --- WASTE WP.STE APPRGVAL
- CONNECTION CHARGE _ E
OWNER'S PERMIT 5 I 11 00
SUR RE
:MEN FE.
AUTHORIZATION
O ISI TION TOTAL i EE ry{y�q }�7�a
�PPROVALS
3 HAVE AT 'PHIS tiATf A t;.O.TdTRAC"f YVITH THE HEREIN NAMED CON- _ _-„ .-_--�__--- j D's7E IINSPECTOk ,,.,i;;id A'i'.URE
TR.ACTOP TO CONNECT THE ABOVEDESCRIBED '._. -. ___--
- �?.ISTING DV��'E.'LUNG
7.G RPt:.eLai SEhVER: NEW HOUSE SEL.'ER
SIGNED THIS DAY Op —.j x' � y 19CONNECT ADDITIONAL - -- � — - -- —
BUILCIN OR WORK
OW
NER OR �f'� s ''
ERS AGENT ��� . g ,v, ---- -- -i- ----`- --- _-- -__-_
SEPT6 TdN K SEEP,PIT[Si i
A,�DY/lR I! IWi t'UEREPY aCKNOWLED E THAT I HAVE P AD' THIS APPLICATION CESSPOOLL_J DRYI'£LLIE:MATE Tt~�.1 THE FlBuVE CJiiRECT AND ,^,(_REE TO COMPLY n L COUNTY ORDiNHNCES AND .STATE LAWS REGULATING� ALT'E'R,REPAIR.SEWER ORP NG ANJ SEWERS SEWAGE DISPOSAL SYSTEM
ERC -ER-�tYTHAT I AM PROPERLY REGISTERED AN llR I �DISGONNEC, LUC AND
NSED AS REOI''h2ED BY LOSS g-M'CELES COUNT�*'AiND 57 E OF PO„,kI A 0R €HAST I M T E Er- 0 VNE,91Of TH AIC VEABANDONbIQUSE SEVERf^ BLVD RES NT1'riL�gfEr, Y `,. BACKFILL SE i TIC TANKS''ATU'RE S .d �/ __ _E;'. T f ) li C SSPJOLSPERM,TTEE
10E-HN A.LA: ,B , COUNTY ENGINEFRALIDTION ROSSERT A. SNOOD, CHIEF P'LBG. INSPECTOR
LASH -
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