HomeMy Public PortalAbout9635 VAL ST_Sewer__ YR"'3eAPPLIC
ww e as A ION F& PERMIT
CODN[Y OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTI/= OF COUNTY MGM=
BOII.DDPG AND SAFETY DrMON BUILDING S
Cw]_ mer ADDRESS
tr A aBIPPm. 800'1 d Dam=G LOCAUT7
NEAREST
FOR O PILIN IN CRO ST
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT /686 DItAIRESS .�
OF BLDGS n
SIZE OF LOT NOW ON LOT Z I
USE OF
BUILDING DIETRICT NO I GROUP YAP P CEBSED BY
eE PG
coNTeACTo
lieADDRESS CONNECTION DASA
CITY TEL NO ;ZW �t STATION DEPTH
ATE MANHOLE REFERENCE UPPER
REGISTRATION NO D�-f COUNTY LOWER
NO p gEg DESCRIPTION F OR FEE �.
PUELIC 9ryCRCONNECTING TO 9� 'LT
SEPTIC T/�NR SEEPAOgg PIT OR IF 43 00 TYPE OF CONNECTION LEIIGTN FHOY
PITS AND/OR ORAINFIELD ! T CURB P L Y L TO P L
OYEHFLOW SEEPAGE PIT DRAINFIELD
C DR L
HOUSE SEWER CONNECT G TO P C NO
IY AA Y I00 CO IMP NO JOB NO
NO XE�XOU09E1SEWER LOG OR 0 11109 TRUNK PERMIT NO ROAD PERMIT NO
A R DIS;g OR ABANDON HOUSEI .,/1 STATE ENCROACHMENT
AL OR $100 PERMIT MO
INDUSTRAPPRD IAL
A
VASTE
CHARGES
OWNIMS PEDUT 2 00 CONNECTION CHARGE FEE
AUTHOB=7ION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT TO CIONNECT THE AAA BOVE DESCRIBED CT WITH THE IIEXISTINGEREIN WA
CON-
TRACTOR DWELLING APPROVALS DATEINSPECTOR 9 SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 18_ NEW HOUSE SEWER
OWNER OR ��� CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDR SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 14 CORRECT AND AGREE TO COYPU CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
I HEREBY CERTIFY THAT I AN PROPERLY REOISFERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BT LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDEUAPL PROPERTY BACKFILL SEPBCTANKS
SIGNATURE SEEP PITS CESSPOOLS 01
OF PERYI
m, VALIDATION ROBERT A WOOD
CL Y.% nER suPBHVIHIHo AeECHANICAL 8No1NRRR
[J-r,o2896�3 JUN Pa 1 0 D 3 .00 �
I-JaA, q/
::E:s!as APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Dop� Dt ComtT Hngin.sr
CGm1T Of Los Aagela BuaO1N
VIM.J FOX. COUNTY ENGINMBR ADDRFS
jW3rT V",
CAGBATTO GRIFFIN,6UYT or BUO-ouw LOCALITY
FOR APPLICANT TO FILL IN NEAREST
OS
LEGAL
DESCRIPTION LOT RO 174 OWNER
BLOCK TRACT MAIL
ADDR
SIZE OF LOT 0 R 0 BLD !NOW ON LOT L NO
USE OF
B ILDINGS )auDISTRICT 0 at
UP MAP
CONTRACTOR BK PG
ADDRESS CONN=ON DATA
CI TEL N STATION 9—`� DEPTH (�
MANHOLE REFERENCE
REGISTRATION NO C] COUNTY j�n'
NO DESCRIPTION OF WORK FEE f W
HOUSE SEWER CONNECTING TOYTYPE CC CONNECTI LENGTH FROM /
PUBLIC SEWER ® ! ! SO CURB P L M L TO P L D
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR .Sd / P C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100 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 GRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 200 RG
OMM'S
pEFLM,r 00 CONNECTION CHARGE FEE
S
AUTHORIZATION 1 TOTAL FEE so REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN AMED COX
TRACTOR TO CONNECT THE ABOVE OES IBEO E%WING DWELLING APPROVALS GATE INSPECTOR 0 SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS AY OF ly NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSN BUILDING OR WORK
ADDREB ESEPTIC TANK SEEP PIT($)
AND/OR GRAINFIELD
1 HER Y CXNOWLEDGE WAY HAY READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER, REPAIR SEWER OR
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTER OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY BY OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I A LEG OW HER TH ABANDON HOUSE SEWER
DESCRIBED TIAL TY BACXFILL SE IC TANKS❑
BEEP PITS CESSPOOLS
BIGNAT RH
OF P RMITTKE
WILL COUNTY ENGINBSR VALIDATION R A WOOD,CHIEF PLeG INSPIK=OR
,LD7 3 9 9.". SEP!3 6 5 �
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