HomeMy Public PortalAbout5450 SARA MAR LN_Sewer__ • ■A.003Bea 1fa1 as'Md APPLICATION-,FOR PERMIT 1
DIVISION OF BUMDING AND SAFETY SEWER—SEWAGE DISPOSAL
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County of Lw Aagala BUILDING
WM J PDX. COUNTY ENGINEER ADDRESS
CAGGATT D GRIFFIN GYP T OF BUILDING LOCALT
FOR APPLICANT TO FILL IN NEAREST
RO84 ST
LEGAL sL LY
DESCRIPTION LOT NO OWNER
BLOCK TRACT C7/ AD NESS 9 7 ,7 T ,E. 0",owl'
NOOF BLDG!
SIZE OF LOT NOW ON LOT CITY C T!L NO
USE OF
CONTRACT! DISTRICT I GROUP YAP
CONTRACTOR `y SK PO
I Al
"DRESS J CONNECTION DATA
CITY STATION iA 41p DEPTH
❑ STATE MANHOLE REFERENCE
REGISTRATION NO ❑ COUNTY UPPER tBAJ.7
TYPE OF CONNECTION LENGTH FROM
No DESCRIPTION OF WORK FEE r CURB P L M L To P L
IHOUSESEWER CONNECTING TO Q
PUBLIC SEWER ® S 350 __
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
,CON N ECT ADDITIONAL BLDG OR CO IMP NO MMIN-49
IMP NO (�J��.J
WORKTO HOUSE SEWER 100 _L=
ALTER OR REPAIR FASTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
.AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL•DRYWELL -- WASTE APPROVAL
SPECIAL CONDITIONS ONLY Z DO CHARGES
CONNECTION CHARGE FEE
OWNEWS FEDW S 1 00
RUTHORMATION TOTAL FEE REIMBURSEMENT FEE
TRACTOR TTHIS O CONNECT T EDATE CONTRA
ABOVECTED WDESCR BEITH THED I t�ING DWELL NG EREIN NAMED CON- APPROVAIn4 DATE INSPECTOR S SIGNATURE
THE PUBLIC SEWER
SI S
SIGNED THIS OF 19—
NEW HOUSE SEWER
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,, IE"P PIT(B)
ADDRES! AND/OR ORAINFIELb
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE! AND STATE LAWS REGULATING ALTER, REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED By LOS ANGELES COUNTY AND STATE OF DISCONNECT
HOUSE SEWER
CALIFORNIA OR THAT 1 AY THE LEGAL OWN THE ABOVE
DESCRIBED RESIDENTIAL PR PERTY 1 / BACKFILL BEP C TANKS❑
99 A
LEEPPIT(II)
ITB CESSPOOLS rl
SIGRATURE
OF PERMITTEE
WILLIAM J PDX.COUNTY ENa1NYat VALIDATION
BY
ADI 2B1 318 CM22 4 2.00 0
DEPUTY DEPUTY
BY
m DEPUTY BY I�♦ ��� DEPUTY
* or AJ, .3 AWA MIR& A— N&
•T�.ABAGG
a a"F ,IR� APPLICATION , FUR PERMIT 1
DMSION OF BUMDING AND SAFETY SEWER—SEWAGE DISPOSAL
m
0ty of d ] gay 9 BUILDING
WM J FOX, COUNTY ENGINEER ADDRESS
CABBAr r M GRIFFIN,{UP T OF BUILDINGr
LOCALI7T
FORA"LICAIAT TO FILL IN A a NEAREST
erose ar
LiOAL
DESCRIPTION OWNER .�
BLOCK CTA I RAIL
ADDRE9
SIZE OF LO • CITY LlNO
USE OF
BUILDINGS r. DISTRICT NO GROU YAP
�wI BK PO r
CONTRACTOR Z�
ADDRESS coxxEcnox DATA
CITY -44 TEL 6TATIOR DEPTH
i ❑ STATE Y EFERENCE
REGISTRATION NO S ❑ COUNTY P ri
E OF CONNECTION LENGTH FROM
no DESCRIPTION OF WORK FEE T CURB P M L TOP L
PUBLIC SEWER- HOSE SEWER CONNECTING TO ® S S SO ! "
HOUSE SEWER CONNECTING TO T ✓Q
PRIVATE DISPOSAL SYSTEM 1 DO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER 100 CO IMP NO MO
ALTER OR REPAIR EKISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
-'AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL•pRYWELL WASTE APPROVAL
SPECIAL CON pIT10N9 ONLY E 00 � CHARGES
FI;LAT 8 PERbUT CONNECTION CHARGE FEE
OT
s t o0
AUTHORMATION I TOTAL FEE REIMBURSEMENT
I HAVE TRACTORTHIS DATE TO CONNECT THEACTED ABOVEWITH THE DESCRIBED "' $TINGEREIN A DWELLING OVALS DATE INlP TOR SSIGNATURE
TO THE PUBLIC SEWER
SIGNED TNIS�,ti_D Y OF 19_ NEW HOUECT A SEWER
OWNER OR J_`ffV(//� CONNECT ADDITIONAL
OWNERS GEN BUILDING OR WORK
SEPTIC TANK SEEP, PIT(!)
ADDRESS AND/OR DRAINFIeLD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ ,I! APPLICATION CESSPOOL DRYWELL❑
AND STATE THAT-THE ABOVE IS CORRECT I A TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR SEWER OR
PLU YBIM6 AND SEWER! 9EWAG8 DISPO�AL SYSTEM
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AMD/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AY THE LEGAL O OF THE OVE
DESCRIBED RESIDENTIAL OPERTT
BACKFILL S6 C TANKS❑
SEEP PGNATURE IT S CESSPOOLS
OF PERMITTEE
Ali
WIL UAM J. FOX.COUNTY ENaLNEua VALMT[ON
,BY ..005f? 0 5nn JUL13 ����YL 4.50 in
DeruTr _. �/1f —Devun
BY BY 1 s;
® DEPUTY DEPUTY
7EA642D ' t
es m INEV wel APPLICATION FOR PERMIT
ml SEWER - SEWAGE DISPOSAL t4p-p -Z Q3i
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN of T lu No GRouP MAr PRo IMSEU BY -
EK PC
�noneea SA/A MAI• (,*,,e S't� 3 Z
LOCALITY Te-"Tele C NECTION DATA
NEARESTSTATKIN DEPTH
CROSS BT e-0 43 W�,
UPPER
_�++ YANXOLE REFERENCE LOWER
OWNER LL /� / ' /YTC71'Z-J TYPE OF CONNECTION LENGTH PROM
ADOMAILRESS J �( 5-a -may/• �/r / +I IDUIWI�
CURB P L M L TO P L
I PC No
CRY GI+P le 1. LNO J—{S/T" -7 P NO bpNO
1
LEGAL K PERMIT NO ROAD PERMITNO
DESCRIPTION LOT NO
DAVIT WAIVER EASEMENT RECORD INSTR NO DATE
BLOCK TRACT
NO OF SLOGS
812E OP LOT NOWON LOT OR ST WIDENING
USE OF
BUUXMNGS ENCROACHMENT
IT NO
CONTRACTOR TRIAL
E APPROVAL
ADDRESS CHARGES
CRY f TEL,NO ECTION CHARGE FEE y
STATE LIC BUREEMENTFEE
LICENSE NO CLASS 7}Vx(
NO DESCRIPTION OF WORK FEEAPPROVALS DATE INSPECTOR881GNATU
HOUSE SEWER CONMKC TO
PUBLIC SEWER NEW HOUSE SEWER
PITS A TANK SEEPAGE PR OR -
PRSANO/ORRCODRAINNECT ECT OR WORKAL
HOUSE SEWER CONNECTING TO IMG OR WORK
PRIVATE DISPOSAL SYSTEM SEPTK TANK SEEP Pm81
CONNECT ADDRIONALB�R AND/OR DRARNFIBLD '
WORK TO XOUBl BlWER �
OVERFLOW SEEPAGE PR DRAWPIELD CBBSPOOL o DRYWILLo
EXTN CESSPOOL DR LL.MANHOLE
ALTER REPAIR OR ABANDON HOUSEI
ALTER REPAIR SEWER OR
FEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM '
DISCONNECT PLUS AND
ABANDON HOUSESSWER
BACKFILL SEPTIC TANKS o I.
OWNER'S
Permit SBEEP PITlelo CE83POOLBo
AUTHORIZATION TOTAL FEE VALIDATION
N ED CON
TRAACTTORR TTHIS
CONNECT THE BOVE DESCRIBED EXISTINGWNG I} � �O L �III , I
TO THE PUBLIC SEWER ��f� d F' l'�-s a a 717.4 A
SIGNED THIS D YOFA-4 CLti�� yL }� _
OWNERS AOHNT � jZ✓ 9� / {' Ca 57 a(q ,X • S p
ADDRE88IJyJ � sl,•� ��� �`/ 2 B B 1a o o-
IX[REBY ACKMOWLSDOE THAT I HAVE READ THITION • B B ' Q,Oo1ANO STATE THAT THE ABOVE IS CORRECT AND AGRMPLY ��j���
WITH ALL COUNTY ORDINANCES AND BTAre LAwATNNO t-UKLY`�`aT� J 0606-79
PLUMBINDANDSEWERB I HEREBY CERTIFY THAT I AM PROPERLY REGISD/ORLICENSED AS REQUIRED BY LOS ANGELES COUNTYE OPCALIFORNIA OR THAT I AM THE LEGAL OWNER OF ANDO RE
SIDE IN THE"ME/DESCRIBED RESIDENTIAL PROPERTY
SIGNATURE / / I '
OF PERMITTER ` 1