HomeMy Public PortalAbout4803 HELEO AVE_Sewer__ ED
S& .663 12.54 U.APLI`0�'A ®. Y®11 • u•• ® PERMIT
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DIVISION OF WELDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING f
WM. J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUP•T-DF.BUILDING LOCALITY G- fLw.� ti
FOR APPLICANT .TO FILL IN ceoss S'. cc,')1L�- el 5 4—
LEGAL
DESCRIPTION LOT NO. ,f OWNER-
BLOCKTRACT = MAIL
ADel-
DRESS
,✓ N0. OF BLDGS.
SIZE OF LOT/7 .�F X � �� �NOW ON LOT �./ � � ,CITY
USE OF -
BUILDINGS ,/.�e.y,<.,r, DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR -
ADDRESS..e_/tq -���.r.. ./CONNECTION DATA
CITY,�S�_x9 ff- �7 TEL. NO.E^".. K. �' .-y R STATION - u.a DEPTH Y
y � ❑. STATE �` f d 1dANHOLE REFERENCE
REGISTRATION 0. ❑ COUNTY � l a 4Z�r - LOWER •
TYP (IECTION LENGTH FROM g
N0. DESCRIPTION�OF WORK FEE Y• CURB ) P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO - •%
'PUBLIC SEWER - n- $ 3.50
HOUSE SEWER CONNECTING TO, - _ --
_ PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. �.� JOB. NO.
WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING f
SEWER OR DISPOSAL SYSTEM 1.00 -T .TRUNK PERMIT NO. ROAD PERMIT N0.�`�
DISCONNECT AND ABANDON-SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATE ENCROACHMENT
SEPTIC TANK, SEEPAGE PIT OR _ PERMIT NO.
'PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL, -
--}-
CESSPOOL- DRYVJ WASTE APPROVAL ELL -
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERIviIT CONNECTION CHARGE FEE
OWNERS $ 1 00
ALTTHORIZaATION TOTAL FEE �"(`} REIMBURSEMENT FEE
I HAVE THIS.,DATE :CONTRACTED WITH THE 'HEREIN NAMED CON- `'R�c
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPRO V�['�Lr7 DATE- ..INSP-CTOR S SIGNATURE
TO THE, PUBLIC SEWER
SIGNED THIS 2 DAY OF 19—
e 7k--- - ,.NEW HOUSE SEWER' .Z,L.. �` c— ` ••
_
OWNER OR
CONNECT ADDITIONAL
a..- �,1 +
OWNERS AGENT- BUILDING OR WORK
y.r-p°^'�+.R-..r -F'�,s ,r=S'Ya--�.'-`"
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.IS CORRECT AND AGREE TO COM-PLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR;SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
HO.PLUG W D
CALIFORNIA OR -THAT 1 AM THE LEGAL OWNER-OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS.❑
SEEP. PIT(S) ❑ CESSPOOLS 1 L��� tt'"V "'""^"•�"
SIGNATURE -
OF PERMITT
WILLIAM J.FOX, COUNTY'ENGINEER VALIDATION
BY
DEPUTY DEPUTY
•.-BY BY
® - DEPUTY DEPUTY