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HomeMy Public PortalAbout5530-5605 TEMPLE CITY BLVD_Sewer__ / 000 76Ae420—CEe0e -10.71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING����..pp ADDREGS� J� LOCALITY A�` C/T !i C ROFOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NOWNAIL BLOCK TRACT ADDRESS N OI eLDOb SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS 015TRICTNO I GROUP MAP PROCESSED BY ex PB CONTRACTOR Mf 1 08 N / 7L C ADDRESS coNNEcnox aATA CITY TEL NO /R STATION S DEPTH ITATIf -17l C[XS[ NOIF CLASS ` may_ MAXXOLE REFERENCE "f UPPER NO DESCRIPTION OF WORK IBE YIE OF CONNECTION '! LENGTH FROM X OUSE SEWER CONNECTING TO CURB P L ML TO P L 0 PUBLIC SEWER 0 $700 p SEPTIC TANK SEEPAGE PIT ON P C NO _ PITS ANO/OR GRAINFIELD C SIG Go CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO a PRIVATE DISPOSAL SYBTEM B 2100 O CONNECT ADDITIONALBLOC OR AFFIDAVIT RYt[[ •[PER RECORD ME" NO DATE U WORKTO HOUSE SEWER C S300 OVERFLOW SEEPAGE PIT GRAINFIELD O EXTN CESSPOOL DRYW{LL O 2800 0 ALTER REPAIR O ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM 0 SS 00ud STAT{ENCROACHMENT MANHOLE 0 $7 DOPERMIT NO d INDUSTRIAL h ���}�p WASTE APPROVAL OTTI{ws FERMT CHARGES AUTHORIZATION CONNECTION CHARGE I!( TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN HAMM CON REIMBURSEMENT FE[ TRACTOR TO CONNECT THE ABOVE DESCRIBED EKISTING DWELLING TO THE PUBLIC SEWER APPROVAW DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF IB_ OWNER OR NEW HOUR[SEWER OWNERS ADEN T � CONNECT ADDITIONAL•OORE86 SU3LDINOOR WORK SEPTICTANK BEEP PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING E ❑ PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER REPAIR SEWER OR LICENSED AS REOUIR[D BY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO OISCONN{CT PLUG AND RESIDE IN THE ABOVE DESCRIBED SIDENTIAL PROPERTY RE m ABANDONICT PL G AND SI WER OF APER MTTTEE_ SAC KIILLS[PTICTANKS ❑ 6E(P PIT ISI ❑ "POOLE VALIDATION cx M 0 CASH lA'n1 0 6 X73 FEB16 1 0 D 1 0.0 0, a ,4_ J 76A e+2D—CE808 —IG TI APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUIL03NO _ �.�b ADORESS 41 LOCALITY FOR APPLICANT TO FILL IN HEAREET D CgOB6 ST L[OAL D[pCgIPTIOH LOT NO OWNER MAIL BLOCK TRACT 3 u y 03 ADDRESS NO OF SLOGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO I GROUP MAP PqO RG CESSEO BY eL CONTRACTOR u 72_ ADDRESS Ioyov, r"ONNECTIDN DATA CITY TEL NO STATION yJJ DEPTH BTA L LIC 1 ' UPPER LIC[ry8E NO CLASP NAHXOL[R[F[RENCE Vl t 3,5 bt- J LOWEfl NO D SCRI 1 N OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE[EWER CONNECTING TO A Y CURB PL ML TOP L PUBLIC SEWER Q $T 00 V a/ �\ SEPTIC tANN SEEPAGE PIT dl PITS ANO/OR GRA INFIELD C SIO GO CO IMP NO ON HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO D- PRIVATE DISPOSAL SYSTEM 0 i]00 CONNECT ADD ITIONAL BLDG OR AFFIDAVIT uTU Paau11T RECORD INSTR HO GATE O WORK TO HOUSE SEWER Y Sam u OVERFLOW SEEPAGE PIT GRAINFIELD DL LXTN CESSPOOL ORYWCLL O ES GO ALTER REPAIR G R ABANDON HOUSE ..-V ORST WIDENING SEWER OR DISPOSAL SYSTEM iB 00 STAT[ENCROACHMENT yl MANHOLE $T 00 PERMIT NO 1 INDUSTRIAL � ���p WASTE APPROVAL OWNERS PERMIT f 3 00 CHARGES AUTHORIZA NJ TOTAL FEE O uO CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING OW[LUNO ArCnOVAT� TO THE PUBLIC SEWER DATE INS ECTORB WGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWN ERE AGENT CONNECT ADDITIONAL IF ADDRESS BUILDING OR WORK BERICTANX SEEP MIT(S) I HERESY ACKNOWLEDGE THAT 1 HAVE RCAO THIS APPLICATION ANO/ORORAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL [IDRYWELL 1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THL ABOVE DESCRIBED gCBI NTIAL Pq0 Y ABANDON HOUSE BE SIGNATURE OF P[RMTTTCC • BACKFILLBCRTICTA S ❑ IS iCCP PITIp) ❑ DOLS VALIDATION c[ M G CASN L & 1 0 7 2] FE816 1 0 0 1 0.00- 49 10 '°" B.:°-`E[o°_LOT' APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FN AA LL- `� LvFOR APPLICANT TO FILL INLEGALDESCRIPTION LOT NO BLOCK TRAC Q 0 _ - NO OF [LOGY SIZE OF LOT NOW ON LOT CITY TEL NO use of BUILDINGS DISTRICTNO GROUP MAPCELSSED BY Bx IB CONTRACTOR .,D 0 op 14 a - /-7 L ADDRESS 44'a j.� CONNECTION DATA CITY TEL NO 4AFFIDAVIT TION �� [PTH STw E lIC 1 UPI[R LICEN6[ I CLwti HOLE REFERENCE 5MO SE SXW I N F WORN F[[ TyP[pP CONNECTION LENGTHMLTO FROM NOUS[6EWCR CONry[CTIXO TO CURB P L ML TOILSEPTICSEWER 1Ir 00BEITICGNK S[CPAOL PIT OR io NPITS AND/OR DRAINFIELO 0 al000IMF NO AOB72HOU.[BEWEN GO...CT..G TOMN PERMIT NO ROAD PERMIT NO aPRIVATE DISPOSAL SYSTEM 0 a]00 OCONNECT AOpITIONAI BLDG OR MT9L TALpEEBT RECORD IN.TR NO DAT[ U WORK TO HOUSE SEWER 0 aS OO OVERFLOW SEEPAGE PIT GRAINFIELD EE QXTN CESSPOOL ORYW[LL 0 SSOO ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING BOJ SEWER OR DISPOSAL SYSTEM 0 S300 STATE ENCROACHMENT IL MANHOLE 0 $% 00 PERMIT NO 1 INDUSTRIAL h [rp WASTE APPROVAL O���rYl ars FEIIMT s 9 00 CHARGES AUTHORIZATIONJ TOTAL. FEE Ov CONNECTION CHARGE FEC 1 HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE IN TORS 16NATURi SIGNED THIS DAY OF 18_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CUILDIN ADDITIONAL RWORK ADDflQ86 BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT 1 HAVE READ TH IB A71ICOMION SEPTICTANK SEEP PITISI ANO/OR DRAINFIELO AND GALL THAT THE ORDINANCES IE CORRECT AND AWS E COMING WITH ALL COUNTY ORDINANCES AND {TATS LAWS REGULATING ❑ PLUMal ryG AND SEWERS CESSPOOL Cl ORYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER REPAIR SEWEROR LICENSED AS REOUIR[D SY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM TME LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE OEBCRIB[D CSID TIAL PROP RTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE SACKFILLSEPTICTANKB ❑ SCEP P1T1S1 CUaPOOL6 VALIDATION Cx mo CASH I Afo 1 0 7 0r� E� 16 1 0 0 1 0.00-- a 16A 642D -CE80S-IO. I APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Bu1LDInG ��P ADDII[BS5�-6Z ��_rZ •G 1 LocALrrr FOR APPLICANT TO FILL IN c[oea aT Q LV OLGCRIPTION LOT NO I OWNER MAIL BLOCK TRACT 3 ADDRESS _ NO OF BLDOY •IIH OF LOT NOW ON LOT TEL NO USE OF BUILDINGR RICT 111 IR,ODU OK MAP ESSED BY CONTRACTOR t I LJ /Y(/ �y [ \ AooR[fs tt hp §[MOLE VV OO I , CONNECnON DATA SETT /S!/t/�P TEL NO 75; TION 2 DEPTHTATE C 6 eCENpL NO J_ZyCyAppREPEflLNC[ a �DO LOWER NO DESCRIPTION F WORK P[CTYPE OF CONNECTION LENGTH FROM HOU SEWER CONNCCTI NO TO CUR[ P L ML TOPL PUBLIC SEWER Y fT 0PEPTICTANK SEEPAGE FIT OR HO OP".AND/OR DRAINFI SLID 0 f100IMP NO SNO (HOUSESEWER CONNECTING TO NK PERMIT NO ROAD PERMIT NO d PRIVAT DI[POSAL[YSTEM SG Oo O CONN ECT ADDITIONAL BLDG OR AFFIDAVIT RMttt TuuuT RECORD INS" NO DAT[ V WONK TO HOUSESKW[R C EG DG OVERFLOW SEEPAGE PIT DRAINFI[LD DC EXTH CESSPOOL DRYWELL Y [S OO HWY OR iT WIDENING O ALTER REPAIR OR ASANDO NOUS ty' SEWER OR DISPOSAL SYSTEM C "GO STAT[ENCROACHMENT MANHOLE 0 $T 00 PERMIT NO O. INDUSTRIAL y �T�p WAST[APPROVAL O��nAYL.[L,S PERMrr f B 00 CHARGES CONNECTION CHARGE F[[ AUTFiORTLATION rorAr. FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FE[ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APlAOVAI� TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF ID_ I I OW HER OR NEW HOUSE SEWER OW NLRS AOENT CONNECT ADDITIONAL ADDRESS BUILOINO OR WORK SEPTI HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR TARA AIBP PIT(S) OR OIIAINFILLO AND STATE THAT THE ABOVE Ip CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGOOL ❑ ORYWCLI ❑ PLUMBING AND SEWERS 1 HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORR REPAIR SEWER OR LICENSED AS REQUIRED BY l0S ANGLES COUNTY AND STAT! OF BE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TONNECT PLUG AND RES ID IN THE ABOVE D[SC IB[D RESIDENT I PROPERTY HOUSG SEWER SIONATUR[OFPRMTTT[ ILLSEPTIC T1 KS PITISI POOLS VALIDATION Id 0 CASH LACO 1 0 7 5/3 6 1 0 D 1 0.00 ^ a TeA etzo -ceeoe-IO TI � , I APPLICATION FOR PERMIT u COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS 'l LOCALITY / N FOR APPLICANT TO FILL IN cR4oea8BY G✓.4V LECAL DESCRIPTION LOT NO / OWNER C L ` L MAIL BLOCK TRACT O ADORES$ N OP PLOT •13C OF LOT NOW ON LOT CITY TEL NO use OF BUILDINGS DISTRICT NO GROUP /p/R MAP RB BED By CONTRACTOR Al, 1 /O(J tl — / � ADDRESS d d le- 49 BAS CONNECTION DATA CITY / A TEL NO y/ !f 5 STATION 5. L, DEPTH ICE N6[TA NO J CLASS ` MANHOLE REFERENCE -•l .J O _ LOWER NO DE CRIPTION O WORK IEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL AIL TOP L PUBLIC SEWER Y $T 00 SEPTIC(ANN SEEPAGE PIT OR NO J PITS ANO/OR GRAINFIELD Y SI000 CO IMP NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 03M TRyNK PERMIT NO ROAD PERMIT NO G- O CONNECT ADDITIONAL BLDG OR AFFIDAVIT RAIt.E [M.SCBT RECORD INSTR NO DATE 0 WORK TO HOUSE SEWER C Si 00 OVERFLOW SEEPAGE PIT GRAINFIELD \ O C%TN CESSPOOL DRYW[LL C SSOO ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM d 53 00 pTAT6 ENCROACHMENT ly MANHOLE 0 $T 00 PERMIT NO y INDUSTRIAL ���}�p WASTE APPROVAL Z OT S PERMIT f 3 00 CHARGEE AUTHOMATION1 TOTAL FEE O CONNECTION CHARGE FEE ITHAVE AT THIS DATE A CONTRACT WIH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED SDWELLING TO THE PUBLIC SEWER APPROVALS DAT IHSP_JIqTOR SSI NATURE SIGNED THIS DAY OF OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL AGGRESS BUILDING OR WORK I HERESY ACKNOWLEDGE THAT 1 HAVE READ L A7 ATP [DISCONNECT PTIC TANK BCV PIT(S) D/OR GRAINFIELD AND STATE THAT THE ABOVE 18 CORRECT AND OMPLY WITH ALL COUNTY ORDINANCES AND STATE LLATING ❑ PLUMBINO AND SEWERS SSPOOL ❑ DRYWCLL 1 HEREBY CERTIFY THAT I AM PROPERLY RENO/ORTER REPAIR SEWER OR LICENSED AS REQUIRED BY L06 ANGLES COUNAND BY OFWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OEND TO PLUG ANO RESIDE IN TH[ ABOVE p[BC ISED R[p1OCNTl LANDON HOUSE SEWER STURE IOF APE NTITECCKFILL SEPTIC TANKS[P PITIBI POOLS VALIDATION c[ M 0 CASH �(`a107413 F 61 0 D 1 0.00 0 7c 16A 642D—cEeoe-Io-'/I APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION SulLDINa ADDRESS 10 h LOCALITY FOR APPLICANT TO FILL IN NEAREST CROS. ST W LEGAL DESCRIPTION LOT NO OW N[R L MAIL BLOCK TRACT U3 ADDRESS NO of Ill 812E OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT XO GROUP MAP SSED BY SK FB CONTRACTOR L _U9 7- �� // A ADORES[ Q 0 r-'i{/ (( CONNECTION DATA CITY ,f & A TEL NO STATION DEPTH 6 OTA IC[NS[ NO �' GL SS �� MANHOLE REFERENCE 2 J � UPPER No DESCRIPTION OF WORK FEE TY pi of CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Aja CURS P L ML TOPIL PUBLIC SEWER 0 $700 (/ SEPTIC TANK SEEPAGE PIT OR Pc. c No- 12-- FITS ANp/OR GRAINFIELD 0 BID Go CO IMP NO JOe NO T HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM 0 S300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT RA(I�• 4t�R�ET RECORD INSTR NO DAT[ If WORK TO HOUSE BE VISIT 0 5300 OVERFLOW 99EPAGE PIT DRAINFIELD O E[TN C"SPOOL DRYWELL 0 55M G ALTERREPAIR O ABANDON HOUSE HWY ORST WIDENING SEWER OR DISFOSAL SYSTEM 0 $3 OO STATE ENCROACHMENT ly MANHOLE 0 fT 00 PERMIT NO 1 INDUSTRIAL H �C�p WASTE APPROVAL Z O��TTITUS PERMIT $ 3 00 CHARD" AUTHORIZATION TOTAL. FEC -42 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE MERSIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DAT[ INSPECTOR 8 GIOXATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OW NERS AGE NT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK BEEP PITIS) HERE BY ACNNOW LEDGE THAT I HAVE READ THIS APPLICATION SEPTIC DRAT HFIELD ANp STAT[ THAT THE ABOVE IS CORRECT AND AOREC TO COMPLY WITH ALL COUNTY ORO INANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AMD/OR ALTER REPAIR SEWER OR LICENSE AN REQUIRED BY LOS ANGLES COUNTY AND STAT[ OF BEWAGE DISPOSAL SYSTEM CALI FO RMIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO pIBCONN[CT FLUE AND RfSlp[ IN THE ABOVE D[SCRIB R IDCHTIAL ROFERTY ABANDON HOUSE SEWER BIG AFERMU`ERTCC BACKFILL SEPTIC TANKS ❑ •[[P FITISI ❑ OOLB VALIDATION CE M 0 CASH LACo1016 1 0 D 1 0.00- 76A 642D-CE808-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _M ADDRESZ 06 LOCALITY / LOCALITY /l GI/ FOR APPLICANT TO FILL IN CRROOM1:SlT �� W °A` LDESCRIPTION LOT NO OWNER MAIL BLOCK TRACT o D3 ADDRESS NO OF SLOGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS NO GROUP MAI R°CESBEO pV p[ RE �y 1 1 CONTRACTOR S d J /"l a — 7 2_ ADDRESS p a V CONNECT40N DATA CITY TEL NO DEPTH STA LIC ® UPPER LICENSE NO CLADifMANHOLe REFERENCE 2'1 ��; NO DESCRIPTION OF WORK FEE E OF COMNEMOM LENGTH FROM HOUSE SEWER CONNECTING TO CURB P L ML TGPL PUBLIC SEWER 0 $7 00 SEPTIC IAMK SEEPAGE PIT Oil NO P MO©�J_PITSANO/OR GRAINFIELD 0 [1000HOUSE SEWER CONNECTING TO ERMIT MO ROAD PERMIT NO a PRIVATE DISPOSAL SYSTEM 0 Sam O CONNECT ADDITIONAL BLDG OR AFFIDAVIT RMT[F t.MELRT RECORD INS" NO DATE 0 WORK TO HOUSE SEWER $ ]00 OVERFLOW SEEPAGE PIT GRAINFIELD O[ [%TN CESSPOOL DRYW[LL 0 $S OO O ALTER REPAIR OR ABANDON HOUSE HWY QRST WIDENING SEWER OR DISPOSAL SYSTEM 0 "GO STATE ENCROACHMENT MANHOLE 0 17 00 PERMIT NO d INDUSTRIAL WASTE APPROVAL Z CHARGES OWN��.S PERMf 9 00 AUTHORIZATION TOTAL FEE p CONNECTION CHARGE FE! 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FE! TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVAIS DATE INSP OR p SIGNATURE SIGNED THIS DAY OF iG_ Li I JF OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK KPT.CI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI4TIOM AND/OR SFIE PIT(5) AHD/OP DRAINFI[LO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLU MEIN° AND SEWERS CESSPOOL ❑ DRYW[LL ❑ ID CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED SY LOS ANGLES COUNTY AND STATE OF SEWAG E DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND NESP°! IN THE ABOVE D[SCRISED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE ❑ OF PERMTTTEE SACKFILL SEPTIC T S S[SP -ITIS) POOLS VALIDATION OX M 0 CASH LAC 1 0 7 1/3 16 1 0 0 10.00- , 76A 64210 -C.E806-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILD Ino k--533T AooRlBE —533 Al LOCALITY L G Lf� FOR APPLICANT TO FILL IN NEAREST DEO.B STX2eb,4 A 4d4 5e LEGAL DESCRIPTION LOT NO MEN (� Jj MAIL {LOCK TRACT �{/ G ADDRESS NO OF SLDGS S12E OF LOT NOW ON LOT CITY TEL NO USE OF BUILDING{ •K p7 D13TRICTNO OROUP MAP PROCESSED BY BUILDINGS CONTRACTOR ADDRESS 11 /A CONNECTION DATA CITY v`W TELNO � ! STATION 3 DEPTH STAT LIC / Q UPPER LICENSE ..Is KO DLA.. \ L MANHOLE REFERENCE a 3, D.M[.[. NO DESCRIPTION OF WORK FEE TYRE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO CURS P L ML TOP L PUBLIC SEWER d fT OD 00 SEPTIC TANK SEEPAGE PIT OR O /J PITS AND/OR GRAINFIELD d LI000 CO IMP NO HOU.[{CW CR CONNECTING TO THUNK PERMIT NO ROAD PERMIT NO y PRIVATE DISPOSAL SYSTEM 53M O CONNECT ADO ITIONAL BLDG OR AFFIDAVIT RAY[. [M[vrt RECORD IX{TR XO OAT[ v WORKTO H OU.ESEW[R 0 5300 OVERFLOW SEEPAGE PIT GRAINFIELD D[ CkTN CESSPOOL DRYW[LL O ..Op ALTER REPAIR OR ABANDON HOUSE HWY OR.T WIDENING O 0 SEWER OR DISPOSAL SYSTEM 0 53 00 STATE ENCROACHMENT W MANHOLE 0 $T 00 PERMIT NO a APP N WASTE APPROVAL Z OTSTETCEYs S 3 00 CHARGE{ AUTHCHIZATION1 TOTAL FEE `l CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCONREIMBURSEMENT FCB TRACTOR TO CONNECT THE ABOVE DESCRIBED 911871NO DWELLING TO THE PUBLIC SEWER APPROVALS DATE IN PCCTOR 0 SIGNATURE SIGNED THIS DAY OF Ip_ OWNER OR NEW HOUSE{EWER 0W. 9 AGE NT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTII HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO/OTANK EFIE PITISI AND/OR GRAINFIELD AND BALL COUNTY THE DIVA IE LAND S AND AGREE E COMPLY WITH ALL COUNTY ORDINANC[B AND {TATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL [IDRYW LLL 1 HEREBY CERTIFY THAT IAN PROPERLY REGISTERED ANO/OR ALTER REPAIR SEWER OR LICENSED AS RCOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO TI PRDI.CON ryCCT PLUG AND RESIDE IN THE ABOVE OESCRI D IOCNOPERTY ABANDON HOUSESEWER AND BIOF ATURE PERMRT[L BACKFILL SEPTIC TANKS ❑ SEEP PI_ SPOOLS VALIDATION cK M D CASH LAr 10730 Fa 100 10100- 0 e 75A 6 D/ TEA APPLICATION FOR PERMIT 4 2 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUPT OF BUILDING LocALrtr FOR APPLICANT TO FILL IN NEAREST cRGae m (PRINT OR TYPE ONLY( Ow D[eCR1PTlon Lor No �' 1 OWNER D MAIL [LOCK TRACT — ADDRESS NO OF BLOCS 812E OF LOT N ON LOT CITY J TEL NO USE OF DISTRICT NO OROVP [LASH MAP PROLE Y BUILDINGS E[ PO CONTRACTOR TH �� ��ADDRESSCONNEC77ON DATA cm N TLL noATION DEPTH LIC[NB[ NO GLNHOIL REFERENCENO DESCRIPTION OF WORK FEETYPE OF CONNECTION LE IRON HOUSE EWER CONNECTING TOCUR[ PL TO P L PUBLIC SEWER O [aEPrlc uNK sccrwGE nr onc No PITA wND/OR DRAINFIELD O [1IMP NO JOBNoHOUSE SEWER CONNECTING TOPRIVATE DISPOSAL SYSTEM O iUXK P[RYIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG ORFIDAVIT R[ .V.R.R! RECORD INST1 NO DATE O WORKTO HODS[SIEW[R BOVERFLOW SEEPAGE PIT GRAINFIELD[KTN CESSPOOL DRYW[LL MANHOLE O ERBT WIDENINGO X_" DONHOU 6 jSgIgNOWD15POSAL SYSTEM ETE ENCROACHMENTRMIT NO Q_ USTRIALSTE APPROVAL Z CHARD"FEn= $ too At"HORMAnON1 TOTAL FEE I f,1&10 CONN[GTIDN CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT F[[ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER AMOVAM DATE INEP[CTOR S SIGNATURE SIGNED THIS DAY OF IE_ OWNER OR NEW HOUSE SEWER OW N[RB AO[NT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 17 SEPTIC TANK BEEF PITIS) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STAT[ THAT THE ABOVE IS CORRECT AND AORC[ TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND aEWERS CESSPOOL ❑ ORYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM TH[ GAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE C I D R ID[NTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE SACKFILL BETANK➢ ❑ Q OF PCRMTrt[[ T SEEP PITIBI ❑ CiESPOOL� VALIDATION JACK ALLEN ' M D CC CASH SUPERVISING MECHANICAL ENGINEER CC R LrLp 70474 JL 8 1 0 0 6.00" CEBOe x/ToV �--" APPLICATION FOR PERMIT CE 2D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION SulLo1No 0 ASL JOHN A LAMBIE COUNTY ENGINEER ADDeeSB l COLEMAN W JENKINS SUPT OF BUILDING Loc^urr Q NEAREST a R APPLICANT TO FILL CROSS ST (PRINT OR TYPE ONLY) LEGAL DESCRIPTION LOT NO OWNER MAIL 1 BLOCK TRACT A 1 _ O ADDRESS / �( No o1 81-008 BILL OR LOT NOW ON LOT CITY TEL NO UeE or A 'S -451 tiS( r/Vl DISTRICT NNO� ORRO-UP CLAff MAP PROC D coRTRAcroR �Q P �d0 1 eK�p ADORES& yf' CONNECTION DATA CITY t TEL NO STATION DEPTH STATE L • UPPER LICENSE NO CLASS MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIOR TH IRON HOUSE S[W[R CONNECTING TO Y CURS Pl. 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