HomeMy Public PortalAbout5703 OAK AVE_Sewer_5/24/1968_CESOB D APPLICATION
C9808
3
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building
FOR APPLICANT TO FILL IN
OESCfl IPTION LOT NO.
BLOCK TRACT
SIZE OF LOT
USE OF
BUILDINGS
FOR PERMIT
SEWER -SEWAGE DISPOSAL
A NG
DRESS
sl�_7 A r AVr
LOCALITY
NEAREST
C R 0 S S ST.
OWNER .L>'D AA�iAIC�/�%/i
AIL
ADDRESS 1-c�� 6C_
MC��
NO. OF BLDGEL
NOW ON LOT CITY ,�.��j�'4,� a/)W. NO.
a DISTRICT NO. GROUP II MAP
�u / �..G ,S^, O y I C._K - 12 0
CONTRACTOR f%/pi�l.S j,%G ��e%7%rC/V _
ADDRESS V%i/ �� �� /�jTrjG iC DNNECTION DATIL
` STATION DEPTH
C ITY�/j CiI/ iEL NN'O. fq��j/,/IJ.�I(JJ�'
HOUSE SEWER CONNECTING TO
AUTHORIZATION
TRUNK PERMIT NO. ROAD PERMIT NO.
15-00
MANHOLE REFERENCE
REGISTRATION NOT' �y�/
` J {�y
LJ t.OUNTY _
CONNECT BLDG. OR
NO. GESCRI PT ON OF WORK
FEE
WAIV[R
TYPE OF CONNECTION
HOUSE SEWER CONNECTING TO
DATE
10
Y. CURB P.L.
PUBLIC SEWER
$5.00
I
I
SEPTIC TANK, SEEPAGE PIT OR
LICENSED AS R qED BV LOS ANGLES COUNTY AND STATE OF
CALIFORNIA OR Hq I A HE LEGAL OWNER ANO INTEND TO
RESIDE IN, THE AB VE SCRIBEIOENT PROPERTf
CO. IMP. NO.
PITS ANO/OR DRAINFIELD
Q S10.00
_
❑'
BACKFILL SEPTIC TANKS
B�PROCESSED BY
UPPER
LOWER
LENGTH FROM
M.L. TO P.L.
P.C. NO.
JOB NO.
OWNERS PERMIT
HOUSE SEWER CONNECTING TO
AUTHORIZATION
TRUNK PERMIT NO. ROAD PERMIT NO.
15-00
PRIVATE DISPOSAL SYSTEM @
S3.00
=
ANO STATE THAT THE ABOVE IS CORRECT
CONNECT BLDG. OR
19_
AFFIDAVIT
WAIV[R
uSEM[xT
RECORD, IN5TR, NO.
DATE
10
O HOUSE SEAL
K TO
33 00
6
I
I
I
LICENSED AS R qED BV LOS ANGLES COUNTY AND STATE OF
CALIFORNIA OR Hq I A HE LEGAL OWNER ANO INTEND TO
RESIDE IN, THE AB VE SCRIBEIOENT PROPERTf
OVERFLOW SEEPAGE PIT. GRAINFIELD
l
SIGNATURE
❑'
BACKFILL SEPTIC TANKS
OF PERMITTE - ---
-
EXTN..CESSPOOL.DRYWELL.MANHOLE @
55.00
ALTER. RTPAIR OR ABANOONPHOUSE
HWY. OR ST. WIDENING
�VALIDLTION
SEWER OR DISPOSAL SYSTEM @
$3.00
STATE ENCROACHMENT
OWNERS PERMIT
$1 z 00
AUTHORIZATION
I TOTAL FEE
15-00
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COW
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
ANO STATE THAT THE ABOVE IS CORRECT
SIGNED THIS DAY OF
19_
OWNER OR
OWNERS AGENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CONNECTION CHARGE FEE
REIMBURSEMENT FEE
APPROVALS
NEW HOUSE SEWER
CONNECT ADDITIONAL
BUILDING OR WORK
CHARGES
DATE INSPECTORS SIGNATURE
ADDRESS
SEPTIC TANK. SEEP, PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE
READ THIS APPLICATION
EL
ANO/OR DRAINFIELD
ANO STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE
LAWS REGULATING
(IDRYWELL ❑
PLUMBING AND SEWERS.
=
CESSPOOL
1 HEREBY CERTIFY THAT I AM PROPERLY
REGISTERED ANO/OR-
ALTER. REPAIR, SEWER OR
LICENSED AS R qED BV LOS ANGLES COUNTY AND STATE OF
CALIFORNIA OR Hq I A HE LEGAL OWNER ANO INTEND TO
RESIDE IN, THE AB VE SCRIBEIOENT PROPERTf
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
l
SIGNATURE
❑'
BACKFILL SEPTIC TANKS
OF PERMITTE - ---
-
SEEP, PIT (5) ❑ CESSPOOLS
i
�VALIDLTION
ROBERT
SUPERVISING
A. WOOD
MECHANICAL ENGINEER
CK. M.O.
CASH
Lilo4 8 0 8 i MAY 24 l o o 5.00- v
f
FOR DEPARTMENT USE
REQUIRED INFORMATION
1. INDICATE ALL BUILDINGS ON PROPERTY.
2. INDICATE FIND DIMENSION SEWAGE DIS-
POSAL SYSTEM WITH TIE DISTANCES TO
BUILDINGS AND PROPERTY LINES.
3. INDICATE SIZE OF SEPTIC TANK -DEPTH OF
SEEPAGE PIT(S)-SIZE OF CESSPOOL(S).
4. INDICATE NORTH DIRECTION ON PLOT.
5. INDICATE BOTH STREETS IF CORNER.
ST. ALLEY R/W
FIELD NOTES