HomeMy Public PortalAbout5429 SANTA ANITA AVE_Sewer__ 77
aE-66s as-ss APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING r
JOHN A. LAMBIE. COUNTY ENGINEER —ADDRESS
GASSATT I).GRIFFIN,.SUPT Or BUILDING LOCALITY
FOR APPLICAN TO FILL IN "Ross sr.
LEGAL^ "
DESCRIPTION LOT NO.� " OWNER
—' MAIL
BLOCKTRACT ADDRESS
t
NO OF ELDGS,
SIZE OF LOT ,y, f. :.�rJ'I014' ON LOT — TCITY TEL. N0.
USEBUILDINGS - -__ --- _- DIST'RtCT N0. GROUP I MAP
_ -_� �� BK PG
CONTRACTOR �d !Q&2 --;
ADDRESS - `�� ,� r - - - -- - CONNECTION DATA
—�-,
�^ STATION - jr DEPTH '�"
TEL. NO u^ ---- -- —
MANHOLE REFERENCE ,�. � _Et_
STATE L7. •' 7 me.
REGISTRATION NO.
NO. ' DESCRIPTION OF WORK � FEE ------- ----..__.— -_.-_-- —
-� - --- ------ - - ------ ----- ------.--,-- TYPE OF CONNECTION LENGTH FROM s d.
HOUSE SEWER CONNECTING TOY_ CURB P.L. M.L.TO P.L. �S t
PUBLIC SEWER -- - --- _ --
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DR_AINFIELO L $3_.00 - —
j OVERFLOW SEEPAGE PIT,DRAINFIELD --�-- P. C. NO.
uI
EXTN.,CESSPOOL,DRY21- MANHOLE n $2.00 --
___ -
-- --- - _ --- ---- E ENCROACHMENT
HOUSE SEWER CONNECTING TO
0TT
PRI
VA UISPO°AL SYb7E M_ -- I RMIT NO.
_ _ $1.00 f TRUNK fl _ ..,- .,. ROAD PERMIT NC?
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER Ci $1.00 e _- r
_4 - -- -- — >—-- --
ALTER,REPAIR OR ABANDON HOUSE i C0 _ l--� -- SigDUSTRIAL -- a °� �. °"X'
kv
SEW CR DISPOSAL SYSTEM '�'
-.i .--- -- CHARGES
1 yl'y
C. NECTION CHARGE FEE
OWNER'S PERMIT DO
---- --- ----- ..__—_�-
RE E
1-T-0—T-AL-4-ii—
� 1
AUTHORIZATION s �_01`
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS. _ I DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS —DAY OF + _i9_ � CONNECT ADDITIONAL j
OWNER OR F e— .- BUILDING OR WORK _ I
OWNERS A(3EN7 .vim / "'-.
SEPTIC TANK,SEEP,PIT(S)
ADDRESS '� fi -'} AVD/OR DRAINFIELD �—
I HEREBY P KNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL EI DRYWELL
AND STATE THf,,T THE ABOVE IS CORRECT AND ACREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING ANI) SEWERS. SEWAGE DISPOSAL SYSTEM 4 _
I HERESY C PTIP Y THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS THE EGAN- LE5 COUNTY P.Nia STATE. CIE DISCONNECT
HOUSE SEWER I
CALIFORN}i�'C5-P,N.THAI' I &M AL OWNEER OF THE A -OTABANDON
DESCRIBED RESID):NTIAL 90,
PERT , - ;+"'�" RA' FILL E.PTIC TAh S i
SIGNATURE i� ..+°'� SEEP P I I ti S; L C _P()OF PERMITTEE a'`z '• - �.
i
JOHN A. LA tBiE, COUNTY ENGINEER VALIDATION i-2GEEfR T A. WOOD, CHIEF PLBG. INSPECTOR
CASH
_ e�
E�ti63 EI.58 78AE-66
"a APPLICATION FOR PERMIT - 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer _
County of Los Angeles BUILDING } ;
JOHN A. LAMBIE, COUNTY ENGINEER -ADDRESS
F CASSATT D. GRIFFIN., SUPT OF BUILDING LOCALITY„-"- � _��. ✓� P° ., - -
�--
FOR APPLICANT TO FILL IN NEARESTCROSS sT.
LEGAL �-
DESCRIPTION LOT NO. T._---� _ -OWNER
AIL
BLOCK # TRACT --J MDDRESS, .J -�_-- - - - i�^.o�"$•...e.,.
t',,r✓ NO.OF BLDGS. -# ti
SIZE_OF LQT py �., ''y NOW ON LOT CITY � TEL. NO.
USE OF ------ar--d-
HUILDINGS DISTRICT NO. i GROUP .. MAP
-- -- -- -- !
BK PC
CONTRACTOR
ADDRESS ---� _--_— CONNECTION DATA
-- --- - -i STATION DEPTH
-- —
CITY -. TEL,. NO. MANHOLE REFERENCE UPPER
STATE
REGISTRATION NO. - d COUNTY
NO. DESCRIPTION OF WORK FEE - - - - -- ----
L ------ ----- ---- - - TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO -Y• __ CUR3 P.L. M.L.TO P.L.
_ PUBLIC SEWER _@ $3.55.0 I L --- ----
SEPTIC TANK,SEEPAGE PIT OR T—
PI'TS.AND/OR DRAINFiELD (,0,, $3.00! ___ ------- ---- - -� _
OVERFLOW SEEPAGE PET, DRAINFIELD P. C. NO,
EXTN.,CESSPOOL,DRYWELL,A",ANHOLE (01 $C,OO.k f CO.IMP.NO. ------.LOB NO,
HOUSE SEWER CONNECTING TO
! PRIVATE DISPOSAL SYSTEM ✓I, $1.00 TRUNK PERMIT NO. __ROAD PERMIT NO. _
CONNECT ADDITIONAL.BLDG.OR I
SEWER. {�L) - STATE ENCROACHMENT
WORK TO HOUSE
_-_- -- _. $L.00 � i PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ft $I. {
_--.. -_----_-_.--, -- --- ---'--- WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'SPERMIT— — -j_ 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE- ---- _T
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- -APPROVALS - 1 YE i[tiSPECTOR_SSIvhAl URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY Of: 1 19 _-
T•-q- CONNECT ADDITIONAL --.-. ...---
OWNER OR t " -.-- `. l~,9 f BUILDING OR WORK -
OWNERS RGENT 8' < I I- l !'7 p --- - --- ----'--- _...-- --- —
� — SEPTIC TANK,SEEP PIT(S)
FICLI - -
ADDRESS AND/OR DRAINO 1
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELLL3
.AND 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUS AND I �
LICENSEDAS REG.UIREU BY LOS ANGELES COUNTY AND S'TA'LE OF ABANDON HOUSESEWER- 1
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED R£SIG JAL PROP RTY. BACKFILL SEPTIC TANKS❑ I
SEEP.PIT(S) i, CESSPOOLS[]
SIGNATURE i -----
OF P£RMITT.EE !
i
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIOP ROBERT A.WOOD, ClflEF PLBG. INSPECTOR
CK. d.0, LAS