HomeMy Public PortalAbout5413 SANTA ANITA AVE_Sewer__ CE 808(R£V.6.'78?1179
Us APPLICAT N FOR , RMIT
SEWER - WAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. I GROUP I
BK PG MAP PROCESSED BY
BUILDING
ADDRESS J -''/, L'' L i` , Il ..�" /' l" .�f�'SF✓�
CONNECTION DATA
LOCALITY
NEAREST STATION DEPTH
CROSS ST. "
UPPE
MANHOLE REFERENCE OWER
OWNER ".t'"1.fFC i �CL s'% `. �.�'.--�';
TYPE OF CONNECTION LENGTH FROM
MAIL Y. CURB P.L. M.L.TO P.L.
ADDRESS
�"/ ""�'�•' p «� CO.IMP.NO. JOB NO.
CITY J` —, TEL.NO. E�
LEGAL TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO.
�C
AFFIDAVIT- WAIVER EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT
r NO.OF BLDGS.
SIZE OF LOT - 4- ,.NOW ON LOT HWY.OR ST.WIDENING
USE.OF
BUILDINGS - STATE ENCROACHMENT
PERMIT NO.
>� J INDUSTRIAL
CONTRACTOR - �"'��' 4 - WASTE APPROVAL
ADDRESS - 4' _ "Y-t°t / / O CHARGES
CITY - y' - TEL.NO. Gy ;t- Com. CONNECTION CHARGE FEE
STATE -+<" C",- LIC. B-iREIMBURSEMENT FEE C'
LICENSE NO. CLASS
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE u
HOUSE SEWER CONNECTING TO O
PU l:fC SEWER
SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWER F
PITS AND/OR DRAINFIELD•, CONNECT ADDITIONAL NJ
HOUSE SEWER CONNECTING TO BUILDING OR WORK ICL
PRIVATE DISPOSAL SYSTEM - 44
SEPTIC TANK,SEEP,PIT(S)
CONNECT ADDITIONAL E(LOG'.OR AND/OR DRAINFIELD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DRYWELL❑
EXTN.,CESSPOOL,DRYWELL.MANHOLE
R.REPAIR OR ABANDON HOUSE /� ALTER,REPAIR.SEWER OR
EWER OR DISPOSAL SYSTEM G SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS❑
OWNER'S Permit
SEEP.PITS)❑ CESSPOOLS:J
�
AUTHORIZATION TOTAL FEEr j VALIDATION"
It�� ( °t�•7r�"�i �= ,y�
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON•
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF i 9zz -
OWNEROR
OWNERSAGENT J - t (-
ADDRESS �p`„e wl 6a"> ✓ " i tr i
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL CATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. -I -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES OU NTr AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER F,A1411 INTEND TORE, i
SIDE IN.THE.ABOVE DESCR! D R S!DENTIA PRORTY. ..
SIGNATURE
OF PERMITTEE
,
Aa4 r, APPLICATION[ FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY' ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ,.
JOHN A. LAr4BI£. County Engineer ADDPzE�s_
WILLIAM A. IFNSEN. Supp of Building
i City -
LOCALITY Te C
_
NEAREST
FOR APPLICANT TO FILL IN ROSS ST D d-n s_.Dr.
LEGAL
DESC PIF'C1O%v LOT NO ,{' ---_ OWNERS
MAIL
i,Or.'iS. TRAL ADDRESS_ -
a
NO. OF BLDG'S.
S i:.`.'E. F L�Or- NOW ON LOT C:ITyN 7€L, NO.
USE OF C. Y. --- --'- --
SL'�IL71h DISTRICT N:6. GFOUP MAF :PROCESSED 9Y
BFC P6
f.Qi*t'RAI.f'U-g¢ g,,,qu,�d,.�. c 1. eaIl k:eT$�`e ",service
r
ADD-.R-E, _— CC3NiION DATA
l
� -=
STATION DEPTH
CITY q- f dS i`°�r5"S"Y-" 'TEL. NO,
STATE Uf�PEf?'
REGISTRATION NO �=•_ '�J L.I,�U H COUNT'( MANHOLE.REVERENCE
Pi O. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM y+
HOc1SE SEWER.CORN LCTIN23 ,U- Y.. GARB F'.L. M.L.'TO P.L.
! @ $
SEWER
PUBLIC 5:00 ___. —..-._ - - _ - __—
I- _.
_-.— P.C.NO
SK C TANK GCE A 'IT O•'vT _�_— JOB NO,.
! P T AND,OR DRAIN ELL- @ y'$10,00 I CO 1 M P NCS
RG`USE S WER NFdEL !N4U TO TRUNK PERMIT NO ROAD PERMIT 10.
PRIVATE DISPOSAL SYSTEM @ $303
--- C
p ONNE - aDD ONAL AFF.OAVkT !tea EFS:F.Nlras RE )RU !NSTR NO. DA'4'i:
+
WORK T O HOUSE SEWERL �^,40 ,� DO �
ZZIOv_R.F.OW SEEPAGE PIT, _RRih a. 3
ExTN.,C]ESSFOOL,DRY WE.L L,M A N OLE $:5.94
AL76,iREPAPR GSR A6ANOON kE 4
HWvOR ST.WIDENING
b ky ER OP D:^aPOSkL SYSTEM _..0 '3.00 I STA TE ENC ROA.CHMEN'T
PEF'MIT Noi
1N 0'.1 ST I AL
WASTE APPROVAL,
J
'is 00
------ y,-y� CONNE( ION CIIARi E FF E.
i HAVE AT THIO DATE A CONTRACT WJTH THE HEREIN NAhY.'F_0 CION- Rkl"ABJ RSm MEN'FEE
7RAC OR TO `-'Q rjECT THE: ABOVE DESC.F';BBD ES.'si"CIfYG ISV E'L L.i,`,I C, --._.__ ____— —_____
7O THE: FUBLIC SEWER. �.PPR6VA.L� .',AT€ I INSPECTOR'S.S!UNATUE:£
SIGNED THIS..______DAl'
i
OWNER OR NEW HOUSE SEWER.
OWNERSCONNECT ADDi710NAL.
BUILDING OR WORK
ADD tib.-.
F9"p77C CANK.SE E.G.PP7 i5) "
I HE'aLElfi k K OY*ff,.FDuk THAT I MAV£ READ 'TTS., APPLICATION AND,.OR DRA!N1ir.I_-1
AND STNTF, TO�AT THE AE30VIE 15 CORRECT .AND AGREE TL's COMPLY
W"THAL' COUNTY ORDINANCES AND STATE LA1,VS REGULATING
[j �J
P!=U Mt3 fvC AND 3EWE:2'u. CESSPOOL- DRYNl E.LL,_'.
I HERR BY CERTIFY Thi AT I AM PROP 15IR Y -REO)STERED AND'OR ALTER. REPAIR,SF,,V R OR
Lr -
LfCChSEO A:$ R', ll.. D BY I..O ANh LE_ COUNT ANLL STATE OF S-WAGE❑7SFfT5At Y..iif�M
CA!_i OR "Al AM "HE LEGAL. OWNER Or ANO INTEND TO
RESOD_ IN, THC ABQV'E D Sf .I> D 3E:SIDr IATiAL 'P RQ46ER?,`; DBS .:`^! d C SESI.IG AND
N i-
AB NllC OL_., ✓JCR
N SF
SI E!4 ATJ F♦E - -� p ✓
OF _RMI.l..TEE - .F !3A CfF LI CnT7c Wu,S
J
- --.- SE.Ei�,r)t S3 L CFSSPQOM3 []'
-VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER