HomeMy Public PortalAbout9657 SPARKLETT ST_Sewer__ FOR PRMIT
PLI
•e e 643 11�5 FBU=MG OA sIIMG AND CSM Y'O N SEW RE SEWAGE DISPOSAL 1
Dopamtnent of Co>mtq Englnser
County of Las Angel" $DI LDING Ir
NESS
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASSATT O GRIFFIN SUP TOF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT XO OWNER /• I�����YFr—I —1
MAIL
BLOCK TRACT �O ADDRESS
NO OF BLDG$ CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF a IFF r DISTRICT N GROUP BK YAP
CONTRBUILDACTOR rI �G
CONTRACTOR
CONNECTION DATA
ADDRESS 419
CITY TEL NO
STATION DEPTH
UPPER
MANHOLE REFERENC
❑ STATE LOWER
REGISTRATION NO ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ S$ 50 Y CURB P L Y L TO P L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD ® $3 00 r
OVERFLOW SEEPAGE PIT DRAT NFIELD P C NO
EZTN CESSPOOL DRYWELL MANHOLE S Z DO CO NO IDB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® 11 00 TRUNK PFRMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $100 PERMIT NO
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
O -$ PE IMT f1 00
AUTH HIZATION TOTALFEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS GATE INSP TOR 991CNATURE
HAVE
TO CONNECT THE ABOVE DESCRIBED UISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER A� ti^7
SIGNED THIS ^AY OF 19— CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGI5TERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANK$❑
SIGNATURE
SEEP PIT($) ❑ CESSPOOLS❑
of PERMITTEE op -
JOHN A LAMBIE.CAUNTY ENGINEER „y,/tI,IDATION ROBERT A WOOD.CHIEF PLeo INSPECTOR
L&5 1 6 9 In FEB 14 4 2.0 O n
\r
�6A6eizo_03 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILD)NG
]OHN A LAMM C.—ty EpgaBu ADDRESS
IVILLIAM A RNSEN Buy i SS Budding
� LOCALITY
N4R[8T �
:FORPLICANT TO FML IN `"°'B ET Saa
aALr _,D[HCRIPTINO OW NCR WNAIL
BLOCKT ADDRESSNO Of BLDOBSIZE OI LNOW ON LOT CITY TEL NOUS, O[•a
BUILDINGS
OF
SUILGIMGB DISTRICT NO GROUP MAR F [[[!O pY
A�O C K PO
CONTRACTOR `
ADDRESS CONNECTION DATA
CITY TEL NO STATION EPTH
REGISTRATION NO A COUNTY I TATE MANHOLE REFERENCE UPP[p
OWER
NO CESCRIPTION OF WORK F![ TYPE Of NNCCTION LENGTH FROM
XOUHE SEWER CONNECTING TO T P L M TOP L
PUBLIC SEWER O Sp GO d
V PF-10
SEPTIC TANK SEEPAGE PIT OR O
PITS AND/OR GRAINFIELD Y [1000 CO IMP NO OB NO 0
HOUBESEWERCONNLCTINGTO
PRIVATE DISPOSAL SYSTEM L]00 TRUNK PERMIT NO ROAD PERMIT NO
CONN[CT ADDITIONAL ELDO OR AFFIDAVIT S.I.[L •Y•R/MT RECORD IXS O SATE O
WORK TO HOUSE SEWER Y [S 00 �� LPLLJ-1
OVERFLOW SEEPAGE PIT GRAINFIELD
[ETM CESSPOOL ORYWELL MANHOLE 0 [p 00 HWY OR ST WIDENINGQ.
ALTER REPAIR OR ABANDON OUSE w
SEWER OR DISPOSAL SYSTEM 0 $a Go STAT[[MCROACNNE Z
PERMIT NO
INDUSTRIAL
WASTER OVAL
OWNHR•S CHARGES
PT 1�L[1 PERMIT' f x 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEC
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON RCIMBURBEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING {� p
TO THE PUBLIC SEWER AMOVAU DAT[ INSPECTOR S BIONATUR[
SIGNED THIS DAY OF 18_
OWNEROR NEW HOUSE SEWER
OW HERS AGE NT
CONN ECT ADDITIONAL
AGGRESS
BUILDING OR WORN
BEPTICTANK SEEP PIT(S)
I NSTATEXRESWY ACKNOWLEDGE ABO THAT I HAVE RLAD THEE APPLICATION AND/OR GRAINFIELD
AND STAT! THAT Y GIMA 16 CORRECT AND AGREE E COMPLY
WITH ALL COUNTY OROINANCEB AND STATE LAWS REGULATING
PLUMBING AND SEWERS ClperoOL ❑ DRYW[LL ❑
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SXW[R OR
LICENSED AS R[OU]RED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM TH[ LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
REBID[ IX THE MOVE DEBCRI.ED RlSIDC�ITIAL PROPERTY ABANDON HOUSE B[WER
SIO NATUfl[ BACKFILL SEPTIC TANKS
OF PERMITTEE O.YLA ,
SLCP PIT($) ❑ CESSPOOLS
/-TAL0 C ROBERT A WOOD
M
cK/) M o CASH SUPERVISING MECHANICAL ENGINEER
LAC0790T2 JAN261 0 D 5.00-
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