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Home My Public Portal About5633 SANTA ANITA AVE_Sewer__ 7SAEn7® 3 Xs E-563 11-55 APPLICATION FOR PERMIT - DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING . JOHN A. LAMBIE, CouNTY ENGINEER ADDRESSiJk� 3 CASSATT D. GRIFFIN, SSUP'T OF BUILDING LOCALITY - ,;.-. _ FOR APPLICANT TO FILL IN NEAREST CROSS sT -- LEGAL -.--- ---_ ----- -----._-------- - OWNER DESCRIPTION LOT NO.-qt�� 0____ MAIL BLOCK TRACY -- _ - -�_-- _ADDRESS ---, -.-- «.-_-- 0. OF BLDGS, SIZE OF LOT y � �-'�' CITY TEL. NO. _ _ _ ----, OW ON LOT _ . 'USE OF-- ��- - ------" -------- ---- DISTRIC�. GROUP I MAP SK PG _BUILDINGS - y CONTRACTOR 5 CONNECTION DATA ADDRESS - - STATIGN ) ' DEPTH-- ,T"^';'e_'___ _ CITY - -_�-_ -_ --TFL NO.__---_ _ MANHOLE REFERENCE , /ugh. sem•,. J y _ llP -- -PER— STATE REGISTRATION NO, , _. -�: �. �.., C COUNTY NO. ! DESCRIPTION 0 F WORK� FEE -. - ------ -- -... -------- HOUSE SEWER CONNECTtN TO i N.rj -�.S TYPE OF CONNECTION LENGTH FROM f _ PUBLIC SEVER @ S 3 0 Q�J Y` _CURB _P.L. !N, L.TO P.L. -_ -I aEPT1C TANK SEEPAGE PIT OR - �••-`'�°''r"'�' •^'5s'C _ PITS AND OR DRAINFIELD 3.00 OVERFLOW SEEPAGE PST,DRAINFIELD �— i. -.:�:' �P C.,AIS?.;- EXfN.,CESSPOt L,02YWFLL,MANHOLE C $2.001 i CO. IMP. NO. JOB NO, - HOUSE SEWER CONNECTING TO j PRIVATE DISPOSAL SYSTEM $1.00 -^� TRUNK PERMIT NO. _ROAD PERMIT N0. CONNECT ADDITIONAL BLDG.OR =�, SuORK TO HOUSE SE!ER r? .� .OG PERALTER,REPAIR OR ABANDON..HOUSE i� INDJim -� T- - -- ----- _ SEWER OR DISPOSAL SYSTEM a 1.00 I� -_-_ WASTE APPROVAL .._u.. CHARGES u �_..._.__ CONNECTION CHARGE FEE ' S - -_- ® Z.• OWNER'S PERMIT � _11 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE wll APPROVALS I I HAVE AT THIS DATEA CONTRACT WITH THE HEREIN NAMED CON- TRACTOR. TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE Pl1BL1C SE`R'ER NEW HOUSE SEWER SIGNED THISDAY OF 3 19 CONNECT ADDITIONAL OWNER OR It ' BUILDING OR WORK I OWNERS AGE" .SEPTIC TANK;SEEP PIT(S — -- g" I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECTAND AGREE TO COMPLY CESSPOOLD DRYWEL_LEI WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HALTER REPAIR,SEWER OR I — PLUMBING AND SEWERS: SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR. -----_--__U _ --- - ------------�-- .�_---- DISCUNNECTPLUG AND LICENSED AS R THA£D BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM E OWNER OF THE ABOVE -- - -- - ----- �- L- - - - DESCRIBED RESIDEI"IT' P ERq1 BACKFILL SEPTIC TANKS❑ ;;I SEEP.PIT(S) ❑ CESSPOOLS❑ I SIGNATURE .-- OF PERMITTEE JOHN A. LAM E,COUNTY ENGINEER //,{d DATION ROBERT A. WOOD, CHIEF PL9G. INSPECTOR bf0. CASH r ( i C IE-808 10- Y' 76A642D - APPLICATION FOR PERMIT COUNTY OF Los ANGELES SEWER--SEWAGE DISPOSAL, DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DI`TISION BUILDING 10HN A. LAMBIE, County Engineer ADDRESS >. WILLIAM A. IENSEN, Supt of Building LOCALITY -. - NEAREST _ FOR APPLICANT TO FILL INCROSS T DESC?IP71 O,t i.J'C NO. - OWNER f MAIL BLOCK TF2.4 C'1` ADDRESS - __ NO. OF B1.OG 5', SIZE OF LOr NOW ON LOT CITY.: TEL. NO. - USE OF HUIL.D Ii`]GS D4STRICT NO. GROUP MAP PRO CESEED BY .._- :.BK PG CONT IAF T'OY?'. .�! ADDRESS nyyNNL�/ &6®NDATA ..__ K�'�� ---_:•«AAAA-..,� ,•._r-- -;:.;-.X+-irv,tT.......:. _ �__...____—�__— ` STATION DEPTH 7FL. NO, ,,�• ,tom._ � TATE +.JWPER - MANHOLEREFERENCEi REGISTRATION NO i� L / SCOUNTY NO_..0 GES_CftSr' IQty OF WORK FEE^- - --_—� TYPE O)"_-ONNE ION LENGTH FROM —_ — 11 HOURE.SEWER CONN£ACTIGN70 � Tri � � CURB P L M.L. 1'O P.L, � _ PUBLIC SEWER $5,00 —� .y __ _. _.. _------_ ,-- 0 — ---- --------_-- P.C.NO. FF,I::TANK,SEEPAGE.PIT' OR - -- JOB NO. P +'�Ah"D;OR DRAINFIELD + $t0.00 CO IMP NO ; _ _ 'HOUSE SEWER CONNECTsNG TO I TRUNK PERWT NO. y ROAD PERMIT NO, pw✓ e.,?1 h O AL b`' TEM $3.0Q TOOL _... _____._ .ALTO / ONNFC: A 7 IOYeAL BLDG OR - AFFlDAVi7 AVER 1 t'Aszmc%T RECORD.INSTP NO. i DATE W WORK TO If U SEWER L $3.II0 1 _-__ O LW LOW SEEPAGE P T DRAIN If:LD XTN ESSP 1'34 OR/4L EL L.MAI OLF $.'.OD _ Al TE:R. REPP.IR OR ABA NOON HOUSE._ I HWY. OR ST.WIDENING SEWER OR DISPOSAWI-STEN,3T , E — _. _.-_ _ $S 'GO STATE ENCROACHMENT PL'RMIT NO. - __ INDUSTRIAL I WASTE AF PROVAL HAF F S._..—. O��JI`1 PERMIT 2 30 - - - - - - - -- - - - CONNEC ON CHARGE FEE AUTHORIZATION TOTAL FEE ---- --- --->--- - ---------- S I HAVE AC THIS DATE A CONTRACT' WiYH THE HEREIN NAMED CON- 32EiMBUR----- —CMENT FEE -- ---- TRACTOR TO CONNECT THE ABOVE DESCRi BED EXISTING DWELLINGyg_ry_y_�.__;_T---_— TO THE PUBLIC SEwcR. ,t -F. APPRO VALS DATE INSPE-T-WS SIGNATURE SIGNED TFiiFi JAY OF OWNER OR NEW HOUSE:SEWER OWNERS EN LEL .» CONNECT ADDITIONAL Ae; BU i LDI NO OR WORK A OD RFSS •." TOOL _. ____.__ ._ __—__._—. —____.—. yLL -- — SEPTIC ANK SEEP,PtT(S) I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND/OR OHAINFtELO ANAD STATE THAT THE ABOVE IS CORRCGT AND AGREE TO COMPLY � WITH AL.L COUNTY ORDINANCES AND STATE, LAWS. REGULATING PLUMBING AND SEWERS. CEFiSPOOL, 0 DRY'WEL.L ❑ 1 i HEREBY CERTIFY THAT AM PROPERLY RL':C'tSTP RED ANC/OR ALTE'.R,RG PAIR,SEWER OR I 1 LICENSE D iCEN EC AS REQUIRED B LOS ANGLES COUNTY AND STATE_ OF SEWAGE DISPOSAL SYSTEM C'AO .LIF PNiA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO IDI BOON NECT PLUG .AND—LTTE ----fl------� ----_— .RESIDE N, THF ABO VE'<s '..SSGi�fk3ED v 54aEN i"f A .,J,pB4`PE RT:'S' nBANDON HOUSE SEWE4 SIGNATURE '� .. —_ — __- �__.__— _ BA KPIL L SEP'NC TANKS ❑ ' OF PERMITTEE _ _ _ — --- SEEP,PIT(S) ❑ c,_,s POOE_5 y-_.VALIDATION ROBERT A. WOOD CK. NN O. CASH SUPERVISING MECHANICAL. ENGINEER 5, � 3'6ASA�D APPLICATION FOR PERMIT ' 1 GE0G8-8.58 COUNTY OF LOS ANGELES SEWER-SEWAGE DIS SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 3UILDING JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Sug't of Building _LOCALITY XEAREST FOR APPLICANT TO FILL IN _CROSS ST. ¢ LEGAL OWNER DESCRIPTION LUT N0. BLOCK TRACT r MAIL ADDRESS - NO.OF BLDGS. SIZE OF LOT NOW ON LOT :ITY TEL.N0. USE OF BUILDINGS DISTRICT NO. GROB,Lp' MAP PROCESSED BY CONTRACTOR i 5K PG { " g �. ADDRESS CONNECTION DATA CITY TEL.NO. �a :STATION DEPTH �j STA'TEUPPER REGISTRATION NO. �] COUNTYMANHOLE REFERENCE - No. DESCRIPTION OF WORK FEE LOWER HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 SEPTIC TANK,SEEPAGE PIT OR 'TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRA)NFIELD @ $3.00 Y cwRB P.L. M.L.TO P - OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ MOO � &J HOUSE SEWER CONNECTING TO P.C.NO, PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO, CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 :R1JNK PERMIT N0. ROAD PERMIT N0, - ABANDON HOUSE STATE ENCROACHMENT SEWER. :SYSTcM fyx..Sj'.00 PERMIT-NO, INDUSTRIAL IVASTEAPPROVAL CHARGES OW'NER'S PERMIT S 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, SIGNED THIS DAY OP I g_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT B-11-DING OR WORK SEPTIC TANK,SEEP,PIT(S) ADDRESS _ AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE, ABOVE IS CORRECT AND AGREE TO COMPLY _CESSPOOL[] DRYWELL[] 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 AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF _ABA.NDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ------ - - DESCRIBED RESIDENTIAL PROPERTY. EACKFILL SEPTIC TANKS[] SIGNATURE SEEP. PIT(S) CESSPOOLS OF PERMITT£ VF, VALIDATIOjI ROBERT A.WOOD CK.. H.o. ' c"It SUPERV14ING MECd-iANICAL ENGINEER Ni