HomeMy Public PortalAbout5131 SANTA ANITA AVE_Sewer__ APPLICATION FOR PERMIT 1
VIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE.COUNTY ENGINEER ADDRESS Z
CASSATT D. GRIFFIN, SOP'T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST -
LEGAL--- - -�----- ---- — --- --- 3
DESCRIPTION LOT NO. OWNER ;r-
BLOCK TRACT -
MAIL ,9
--
-- NO.OF BLDGS. `CITY TEL. NO..
SIZE OF LOT NOW ON LOT
USE OF ^--_---'._'- - DISTRICT NO. GROUP -
BUILDINGS �,. S BK MAP PG
CONTRACTOR --------- --- �.,.^+ —_ .'S
CONNECTION DATA
ADDRESS ----- _,d- ---- — --
CITY - —+ --TEL.NO. STATIONs� DEPTH �- -
----.----- _--- ---_--- _-- MANHOLE REFERENCE - UPPER
O STATE _ _ —_ LOWER
REGISTRATION NO. [,� COUNTY
NO. DESCRIPTION OF WORK FEE .— ------ -- .--- ._
TYPE OF CONNECTION -LENGTH FROM
I HOUSE SEWER CONNECTING TO ' Y. CURB P.L. M,L.TO P.L.
PUBLIC_SEWER @_$3.50
---- ----- ---
-- SEPTIC TANK SEEPAGE PIT OR - J
PITS AND/OR DRAINFIELD _ r $3.00 i
I
OVERFLOW SEEPAGE PIT,DRAINFIE.LD P C. NO.
EX1N.,CESSPOOL,DRYWELL,MANHOL,E G: $2.00 j �� CO. IMP. NO. ?OB NO.
HOUSE SPNER CONNECTING TO
_LPP VATS DISPOSAL SYSTEM (r. $1..00 _ TRUNK PERMIT td0 ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG OR 1 � STATE ENCROACHMENT -
SVORK,TO HOUSE SEWER $t-90-i PERMIT NO.
ALTER,P-PAIR OR ABANDOSASYSTEM ON HOUSE --.--- ------^-----�-
SEWER OR DISPOSAL (` INDUSTRIAL
---- ---- $I. —` WAISTS APPROVAL
CHARGES
_
CONNECTION CHARGE FEE m. 7S0-1 " e:- .
OWNER'S PERMIT I 1 GO ---- - -- - - -^— —
---- ------- --- I-_-00 REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE � ! Tf T
I HAVE AT THIS CAFE A CONTRACT WITH THE. HEREIN NAM. D CON- APPROVALS I DATE i!NSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER I +
SIGNED THIS DAY 0r_ --�19--- CONNECT ADDITIONAL f
OWNER OR BUILDING OR WORK
.OWNERS AGENT-----------.- SEPTIC TANK,SEEP.PIT(5) ,
ADCRESS .-_ _-� AND;ORDRAINFIEL6_---_ _._I_..-.-----I------ ___-.---
I HEREBY ACKNONLELGE THAT I HAVE READ.THIS APPLICATION CESSPOOL[] DRYWELL❑
AND STATE IHAT THE ABOVE; IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR +
PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED ANDiOR DISCONNECT PLUG AND _-- -�� --_----�`----
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF .ABANDON HOUSE SEWER +
.CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ___._-_.---___--i-_..--�;- ------ ----_.__--
SIGNATURE. � ''.;y t__-- SEEP.PIT(S)_L�,CESSPOOLS-Ll--l------------...�.--------__---
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS I I
OF PERMITTEE -- ' f
IOHiN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
9
gg �} �[ C.K. N.0
76A642D
APPLICATION FOR PERMIT
BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
J County Engineer
A LOS Angeles BUILDING - -.
COUNTY ENGINEER ADDRESS �._,_- _-------------___ _--_---. --
'; ,-IFFIN,SUP°T OR BUILDING LOCALITY
tUl P.,.PP" ICANT TO FILL IN NEAREST
CROSS ST.
LEGAL — -- -"- -- _------
DESCRIPTION LOT NO. OWNER
BLOCK TRACT - MAIL
�_. ADDRESS
N0. OF BLDGS. -
S1F LOT NOW ON LOT i—.-_-- CITY TEL. NO.
Z C_
USE OF '—
BUtLDtNGS_ DISTRIC!;-,NO. ! GRO;UP MAP
SK PG
CONTRACTOR
ADDRESS ---- CONNECTION DATA
CITY TEf... NO STATION ,4- _ P�'p DEPTH
!7 STATE MANHOLE REFERENCF,,�4q�T
REGISTRATION NO, - COUNTY
----
NO.I DESCRIPTION OF.WORK S FEE ---.---- - —..T_� -- -----
TYPE OF CONNECT ON LENGTH FROM1 45
'-- ['OU.+t F4!ER CONNFCT!P�, 'IO ... I,-.. ..-"ro Y 'A - ,,.A:
—�PUfs L1C NER_ (ti! $ 3 50 — '-- '--M.L. TO P L�T�___.
HOUSE SEWER CON WECT(NG TO�
PRIVATE D SPOSAL SYSTEM 1.001 t ---
(
CONNECT ADDITIONAL BLDG, OR
WORK_O HOUSE SEWER_ 1.00
ALTER OF,REPAIR E-I,i'INc.
SEV_R_OR DISPOSAL SYSTEM _ 1.00TRUN C PERMIT NO ->? ,' ROAD PERMIT 120
t
DISCONNECT AND A'BAI` )O`{ SEATER STATIC ENCROACHMENT—
l ANDIOF
DISPOSAL SYSI ,:5,
_ 1.00
PERMIT PnPq T NG
SEPTIC TANK,SEEPAGE PIT Oi
_ PITSIINDLSTRI LN `_ L_ _ _ _ WASTE APPROVAL
CESSPOOL •ORYWEL
---`-__---
SFECIAL CONDITIONS ONLY 2.00 ---- CHARf�ES
1 _ — ---- ---- -- - -- --- '-- ---
OWNER'S _PERMIT S I i QO CONNECTION CHARGE FEES ��: ,� s --
AUTHORIZATION TOTAL FEE I� .lam REIMBURSEMENT FEE �A
I PAVE THIS DATE CONTRACTED WITH THE HEREIN MED CON- ty
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS BATE INSPECTOR'S SIGNATURE 1
To THE PUBLIC SEWER
SIGNED TxIS
NEW HOUSE SEWER -�--- --- --- — -.___
_._—DAY -_� 1� _
DOWNER OR CONNECT ADDITIONAL 1
OW1r`ERS LGEPdT_.,______._.,..______,�._..__ _.,...--�_____._._.__-.__ BUILDING OR WORK -
SEPTIC TANK. SEEP, PIT(S)�
DRAL F!ELD FIELD---
I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O L}ORYWELL -�-
AN0 STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE. LAWS REGULATING ALTER,REPAIR,SEWER OR _
PLUMBING AND SEWERS, SEWAGE DISPOSAL E
1 HEREBY CERTIFY 'THAT I APA PROPERLY REGISTERED AND/OR GE DISPOSAL SYSTEM- GE - -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND -
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF TH-t ABOVE ABANDON HOUSK SE4Y.EP. _ _ _
DESCRI:,:D RESIID€NTIAL PP:OPERTY. BACKFILL SEPTIC TANKS C I
SSGNATUR 6- SEEP. PIT(S) C CESSPOOLS 0
OF PERMITTEE Y -
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF PLBG, INSPECTOR