HomeMy Public PortalAbout4814 HELEO AVE_Sewer__ 76A6FOR PERMIT
6&
E•-66663 3.55 APPLICATION "
DIVISION Of BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depoatment of County Engineer
County of Los Angeles BUILDING
ADDRESS. e
WM.J. FOX, COUNTY ENGINEER
{ CASSATT D. GRIFFIN SUPT OF BUILDING LOCALITY '
FOR APP ICANT TO FIL IN NEAREST
CROSS ST: ,.1
LEGAL
DESCRIPTION LOTNO. 00')d OWNER
BLOCK TRACT MAIL
ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT >� CITY LTEL. NO e !•
USE OF
BUILDINGS - DISTRICT NO. I GROUP MAP
P
CONTRACTOR
ADDRESS �- ;�� '' CONNECTION DATA
CITY TEL. N0. STATION DEPTH
�S u �•i. ❑ STATE MANHOLE REFERENCE
REGISTRATION NO. l�// d' G' .! `(]•=COUFITY• / OWER e
NO. DESCRIPTION OF WORK FEE _
TYPE OF ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO _" dl�
/ PUBLIC SEWER @ $ 3.50 ') -� M.L. TO P.L.
HOUSE SEWER CONNECTING TO
PRIVATE-DISPOSAL SYSTEM 1.00 - -
CONNECT ADDITIONAL BLDG. ORP.P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. 161 P. NO. / I/� JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM f.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER ENCROACHMENT
STATE ENC
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK„ SEEPAGE PIT OR _
PITS AND/OR DRAINIFIELD' 3.00 INDUSTRIAL
- WASTE APPROVAL
CESSPOOL- DRYWELL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNER'S,
' 5 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE �
1 HAVE-TH.IS DATE CONTRACTED WITH THE.HEREIN-NA ED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING_ APPROVALS DATE INSP CTOR'S SIGNATURE
TO THE PUBLIC SEWE _ _ f,
w NEW HOUSE SEWER
SIGNED THIS�CZ 1,9 ` eDt
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR'.WORK
SEPTIC?ANK, SEEP,PIT(S) -
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT F HAVE READ THIS APPLICATION CESSP-OOL.❑. DRYWELL❑ -
AND STATE THAT THE ABOVE IS CORRECT AND,AGREE TO COMPLY "
WITH ALL COUNTY ORDINANCES AND STATE* LAWS REGULATING ,ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. '• SEWAGE DISPOSAL SYSTEM '
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -
LICENSED AS REQUIRED BY LOS ANGELES' COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY• B [ISIGNATURE ACKFILL SEPTIC TANKS
e SEEP. PIT(S) [I CESSPOOLS
—��
OF PERMITTE - -
WILLIAM J.FOX.COUNTY ENGINEF-If VALIDATION R.A.WOOD. CHIEF PLEIG. INSPECTOR
' C 8 3 6 rJlJL 18 4 4.5