HomeMy Public PortalAbout4857 HELEO AVE_Mechanical_9/1/1953_11855S HOUSE SEWER CONNECTION TO PUBLIC SEWER DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF` BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEERI BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING
NEAREST// e / NEAREST
ADDRESS CROSS ST.
LOCALITY ��/ �D�,� G 4 X, � DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST /'o A
A
CROSS ST. /)u/�y Z ✓,Sd t-LA�e&
OWNER
do 4 �F RECEIVED BY Ready for Inspection DATE ISSUED
MAIL �� �. ®R �J2/A/Mt="ltt' ,C��iat �„��•P�'
ADDRESS �s�� ��`�Sp, 11XIle® 4VAe USE ZO�NyE7 ��`O/CCUPANCY' MAP
CITY BK PG
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CONTRACTOR �-
CO.IMP.NO.
ADDRESS
JOB NO.
CITY T .NO TRUNK PERMIT NO.
STATE
REGISTRATION N0. 1�` ❑ COUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. �, 3 U STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 133 A INDUSTRIAL
0 NO 8F BLDGS. WASTE APPROVAL
SIZE OF LOT.2� ��. �S NOW ON LOT \` CHARGES
USE OF
BUILDINGS /,�/���////'>r�s CONNECTION-CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE--,
/ PUBLIC SEWER @ $ 3.50 si L5 RECEIPT NO. -,DATE' BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
SEWER OR DISPOSAL SYSTEM 1.00 N0. I DATE I BY
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION 6; y DEPTH /
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE
.3 /' . c7 URN.
OWNERS
TYPE 0,F-CO.N•NECTION LENGTH FROM L
OWNERS PERMIT I 00 �Ye S 'PSL. M.L.TO P.L.
AUTHORIZATION TOTAL FEE cSG
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
/
SIGNED THIS------Al-----DAY OF--_A9&Ae_r------_.19d! , NEW HOUSE SEWER
OWNER OR /�`V ���56 BUILDING OR WORK
NECT AL t
OWNERS AGENTpS► .-•-!YA[�i��t� �y ...-•--�--
ADDRESS----Y(,PA?.-.,7---fX_�_�_- 4� ...... e,-------_--- SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
CAI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL❑
TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE EG L OWN-
ER OF THE ABOVE SCRIBED RESID T P T BACKFILL SEPTIC TANKS I]
SIGNATURE
SEEP.PIT(S)� CESSPOOLS
� �7/ '
OF PERMITTE
76A642D 663 1/53 /�