HomeMy Public PortalAbout5327-5329 SANTA ANITA AVE_Sewer__ 6A 642D -V01306 10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY -�
FOR APPLICANT TO FILL IN NEAREST CROSS -
CROSS ST.
LEGAL
DESCRIPTION LOT NO. < _ OWNER
,� .�. MAIL a= `I. k�rl-), /e. d
BLOCK TRACT ADDRESS Lf/
td �` NOWOON LOTS CITY '/11,1
j TEL. NO. ��
SIZE of LOT �re�s� �Y-!1 ,N, ,� _
USE OF
BUILDINGS DISTRICT N0. GROUP "AAP ,PRO Y5E 0 B'�
r`
CONTRACTOR
ADDRESS CONNECTION CONNECTION DATA'
CITY - - ` STATION J t,' / q7 DEPTH ,.
/.f L.. -..TEL. NO. ✓ 7A -I _(-,1'
STAT y�d �j LICMANHOLE REFERENCE
CLASS .. I'�' /--: .,� 9..� .• �' LOWER
NO. I DESCRIPTION OF WORK FEE TYPE OF CON14ECT16 LENGTH FROM
I HOUSE SEWER CONNECTING TO _ Y. CURB P L M.L.TO P.L.
l PUBLIC SEWER Q $7.00 �I f 3 _. Yl
P.C.NO,
SEPTIC TANK.SEEPAGE PIT OR .lN1P NO.
PITS AND/OR ORAINFIELD CO
510.00 _ JcOB NO. \
HOUSE SEWER CONNECTING TO TRUNK PERMIT,46 ROAD PERMIT'NO.
I -
PRIVATE DISPOSAL SYSTEM S3.00 rI "�! _ -`
CONNECT ADDITIONAL BLDG.Olt" AFF1Dpr T w WarvEII EASEMENT - RECORD.INSTR.NO. DATE
WogdbWTO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.,CESSPOOL.DRYWELL, 55.00 HWY.OR S,i.."'YViOENINCs, -�
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 53.00 STATE-ENCROAE,4f0ItNT
MANHOLEPERMIT NO
$7.00 --- r - —
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT'—_--- -
CON CION CHARGE FEE
AUTHORIZATION TOTAL FEE I� 1" '' '
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT -- '
CONNECT ADDITIONAL
ADDRESS
BUILDING OR WORK ?SEPTIC TANK.SEEP,PIT(S) _
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
WITHALL COUNTY ORDINANCES AND STATE LAWS RjiGULATiNG
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL. ❑
1 HEREBY CERTIFY /,0C
M PROPER ,�REG[ ED AND ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRS ANGLES .CO AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT LEGA NER F, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVEB `-R Ipl NT AL PROPERTY. gggNDON HOUSE SEWER
- �.SIGNATURE j -`� .1"`�,_.�_� ..EAC KFILL SEPTIC TANKS ❑
OF PER MTTTEE�"' _ SEE P.PITS) ❑ CESSPOOLS ❑
VALIDATION CK. M.D. CASH
422 fi'onu _�, u U J... v ;
.j L
6A '�'� ::606 -10-71.. APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING Jr-?
ADDRESS -,/jr'y L' 1
LOCALITY y
FOR APPLICANT TO FILL IN NEAREST —
CROSS sr.
LEGAL
DESCRIPTION LOT NO. f1—s-G/ OWNER
( MAIL
BLOCKTRACT ADDRESS
y } '
_ Il/, /t el� NO. OF BLDGS
SIZE OF LOT Cf NOW ON LOT .•�T'' ``..'✓✓11 CITY TEL. NO.
USE OF �-_ //
BUILDINGSG"�,, _. �= Gr�--��""� DISTRICT NO. GROUP MAP PR OCE SED BY
PS
CONTRACTOR r e'eaz _
ADDRESS x'41 , L t CONNECTION DAT
"9 l -"3 STATION / DEPTH
CITY - ,: � iJ:- j`..� TEL. NO. _ .id, J s` ��- fes;•
STATE ,P7t` �.", ,} ? LIC MANHOLE REF NC _ UPPER
LICENSE NO, JV V� �I CLASS
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM _
HOUSE SEWER CONNECTING TO n Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER $7.00
SEPTIC LANK,SEEPAGE PIT OR - -� -i r �, P.C.NO,
PITS AND/OR DRAINFIELD @ 310.00 CO.1 N.P. '7-i _ '.,-� JOB NO.
.HOUSE SEWER CONNECTING TO }
_ TRUNK PERMIT NO. "j t Y ROAD PERMIT NO: CIL
PRIVATE DISPOSAL SYSTEM $3.00 .a �.^'` g
r CONNECT ADDITIONAL BLDGMt AFFIDAVIT WAIVER[EASEMENT RECORD:INSTR.NO. DATE U
1MT0 HOUSE SEWER @ 33.00 ti
OVERFLOW SEEPAGE PIT,DRAIN FIELD __ a
EXTN,CESSPOOL,DRYWELL. @ 35.00 Hyyy ,WIDENING r O
ALTER,REPAIR OR ABANDON HOUSE -..A
SEWER OR DISPOSAL SYSTEM @ _$_3.00 g ATE ENCROACHMENT
-_ MANHOLE Q $7.00 RMIT NO.
—__ i UR jAI.
"' W TEA AFgdVAL Z
OWNERS PERMIT ; ON .� CHARGES
AUTHORIZATION TOTAL FEE 1 co ECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REI URSEM Pee"
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, "APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF--19—
OWNER
F19_OWNER OR NEW HOUSE SEWER •'
OWNERS AGENT -- -
CONNECT ADDITIONAL
BUILDING OR WORK
'-ADDRESS_ AND/SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD f"j,ov${5: - �`f' '4 �`L.• '
WITH ALL COUNTY j
AND STATE LAWS REGULATING
PLUMBING AND SEWECESSPOOL ❑ DRYWELL ❑ �+ - �pa�` �¢, :"
1 HEREBY CERTIFYPROPERLr, REGISTERED AND/OR ALTER,REPAIR.SEWER OR �}
LICENSED AS REQUIrAGLES�.Cp('� Y AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THATG L nV OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB RE OEN AL PROPERTY, ABANDON HOUSE SEWER
SIGNATURE BACKFILLSEPTIC TANKSOF PERMTTTE �1_,..- _ ❑
SEEP,PIT(s) CE
El
VALIDATION CK. M.0. CASH
42 U �. 1 .