HomeMy Public PortalAbout5233 SANTA ANITA AVE_Sewer__ 7Gh
E-669 92..54 APPLICATION FOR PERMIT 1
6 G •55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Lass Angeles BUILDING
L DI G
V4/Idt. .t. FOX. COUNTY ENGiNEFR CASSATT'D. GRIFFIN.SUPT O'" BUILD?NG LifiY
0 1
FOR AFFLICANT TO FILL IN NEAREST
- CROSS ST.
LEGAL - - -
DESCRIPTION LOT NO. OWNER
- "
.•..�''"ti-. �
BLOCK TRACT s MAIL
-�+-. .- -ADDRESS �, -
IS�J OF B:DGS.
SIZE OE LOT - NOi+V ON LOT _. .
._ ""�,�.._-------- � CTT NO.
USE OF
BUILDING5.�. DISTRIC 'O. OUP MAP
SK
_ 1 BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL. NO. STATION DEPTH
[] STATE ��. -MANHOLE REFERENCE - -----
REGISTRATION NO, COUNTY -- UPPER
—_- --"`".- - TYPE OF CONNECTION'-. LENGTH FROM: -----
No. f DESCRIPTION OF"WORK FEE Y. _CURE P.L. M.L.TO P.L.
HOUSE SEWER GONN.ECiING TO 1
PUBLIC SEWER �� 5-3.50 '
HOUSE SEi"4ER CONNECTING TO .�
1 PRIVATE DISPOSA SYSTEM 1.00 ( .� ------------- - --._. -----
CO''Iw ECT ADDITIONAL BLDG. GR I CO. IMP.NO .TOB. NT).
WORK TO HOUSE SEWER
ALTER OR REPAIR EXISTING
1 SEWER OR DISPOSAL SYSTEM i.00 � I TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER 1 STATE EPtCROACH:MzNT
AND/OR DISPOSAL SYSTEM - 1.00 5 �`
_._ _.- __-_--_ PERMIT NO.
SEPTIC TANK SEEPAGE PIT OR ---------
PITS_Ai3D/O_R DRAINNrLD .-1 00 -INDUSTRIAL
CESSPOOL-DRYWELL -_ -� -- WAST_-APPROVAL
SPECIAL CONDITIONS ONLY 2.000 I r -CONNECTION CHARGE FEE
CHARGES
CON
p$l$N�lIT`
O ( EWS S t f 00 -
AUTHORIZATION TOTAL FEE +--f- REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED ICON- APPROVALS DATE INSPECTOR'S SIGNATURE
TO
TO CONNECT THE ABOVE DES MBED Ea1STTNG DWELLING
TO THE PUBLIC SEWER. -------A--- --- —
SiGNFD THIS _ D 0. 19,E«... NEW HOUSE SEWER v -�
OWNER OR CONNECT"ADDITIONAL
OWNERS AGE.N - .:.._BUILDING OR'NO
SEPTIC TANK SEEP, PIT(S)
A.DD ESS_„_L._ _ - _ -.. _ AN_D_/OR DRAINFIELD.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION_ CESSPOOL CJ DRYWELL 0
ANO 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 SYSTEM
I HERESY CERTIFY THAT I .AM PROPERLY RFGISTERED AND,OR DISCONNECT PLUG AND ^--s - - - -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE P.BANDON ROUSE SE1?lER
DESCRIBED RESIDENTIAL 'PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP PPIT(S} [l CESSPOOLS❑ __ _
SIGNATURE - _
OF PERMITTEE _
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
Til" d oAN 3 7 9 4 8.8 35 ![ BY
DEPUTY DEPUTY
BY
DEPUTY DEPUTY
76A6
E- 63!2.•54 APPLICATION - FOR PERMIT ]�
. &E•6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING - "� j e
WM.J. FOX, COUNTY ENGINEER _�-
CA56ATT D. GRIFFIN, fsuP'T OF BUIL.,.G `r i-'�
LOCALITY y _
M=j
FOR APPLICANT TO FILL IN _NEAREST �,
�__.. CROSS ST., �.�. .r +�.Y..•- �� d.
LEGAL
_DESCRIPTION LO'i N0. r... `OWNER
BLOCK TRACT " MAIL
..•''•+`+ � a.✓,,. .."" _'". �
�f d NO OF BLDGS.
SIZE OF LOTy� .,,_, N0+4 ON LOT CITY TEL.
/5
USE OF b
BUI DING5x �•'- DISTRICT NO. GROUP MAP
BK PG
GONTRA.CTOR, �/, F '.
ADDRESS r' -- — _ CONNECTION DATA —i
CIT)l _ r A� TES. v � X STATION DEPTH
(] STATE MANHOLE REFERENCE
REGlSTRATtN ND, r+r LAI COUNTY I UPPER
TYPE OFCOtaNEGC1CIV LENGTH FROM
NO. 1 DESCRIPTION OF WORK FEE Y. C r.�� M.L.TO P.L.
HOUSE SEWER CONNECTING TO
�".
PUBLIC SEWER_ _ � $ 3.50
HOUSE SEWER CONNECTING TO !
PRIVATE DISPOSAL SYSTEM _ ,1.00 _ — ---
I CONNECT ADDITIONAL BLDG. OR �j —ji CO. IMP. NO. JOB. NO,
WORK TO HOUSE SEWER I.06 - �-
ALTER OR REPAIR-FX€ST!NG i
�I SEWER OR_DISPOSAL SYSTEM __ 1.00 ! TRUNK PERMIT NO. ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
At_D/OR DISPOSYSTEM AL S 1.00.. � FERMIY NO.
SEPTIC TANK,SEEPAGE PIT OR —
PITS ANWOR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL - DRYWElL -- 'WASTE- APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
— —'-- ' — CONNECTION CHARGE FEE
Ow7mrS P T I---j I 00
AUTHORIZATION TOTAL FEE--- REIMBURSEMENT FEE_
I HAVE THIS DA"E CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER .--
SIGNE'D THIS._ DAY OF___�__—. 19 NEW HOUSE SEWER -- �� ----
OWNER OR _i _x C
OWNERS AGENT' Otd NECT ADDITIONAL
:iuj BUILDING OR WORK
—SEPTIC TANK, SEEP, PITIS) _-
ADDRESS_._._—. / AND'OR DRAIid FI£LU
I HEREBY ACKNOWLEDGE THAT I HAVE READ!_7,i"',
PPLICATION CESSPOOL 0 DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE:DISPOSAL SYSTEM
I CERTIFY ERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
CE
LINSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVETABANDON HOUSE SEWER __
DESCRIBED RESIDENTIAL PROPER'l'Y. BACKFILL SEPTIC TANKS Cl
SEEP.
PIT(S) C3 CESSPOOLS'[]
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX.COUNTY EN ,' EE2 '{VALIDATION
BY BY
DEPUTY DEPUTY
BY BY
DEPUTY DEPUTY