HomeMy Public PortalAbout4819 HELEO AVE_Sewer__ ' p��g � gp�q PERMIT
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8&E-663 3.55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County'of Los Angeles BUILE N
ADORER;
ADDRESS
WM.J. FOX,,COUNTY ENGINEER -
°® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY ��' G •'r'
NEAREST
FOR APPLICANT TO FILL IN- CRoss
LEGALI If
rLF
DESCRIPTION LOT OWNE '� .
BLOCK TRACT MAIL y
ADDRES � Lr.�y
SIZE OF LOT NOW ONBLOTS CITY TEL. N0. . ���� /.� -
USE OF
BUILDINGS I . . IN c— _ DISTRICT NO. GROUP MAP
-CONTRACTOR °'•' I r L BK -
ADDRESS // S CONNECTION DATA
CITY TEL, N0. STATION DEPTH .
❑ STATE MANHOLE REFERENCE .:.,e('- UPPER
REGISTRATION NO. - ❑ COUNTYy -
NO., DESCRIPTION OF WORK FEE TYPE NECTION LENGTH FROM
HOUSE SEWER CONNECTING TO @ ' Y. CURB P.L': M.L. O P.L.
$ 3.50
PUBLIC SEWER --�-
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR / P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. Ih1P. N0. 7 JOB NO,
.ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. (J®�
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD - 3.00 INDUSTRIAL '
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SE Eft
SIGNED THIS �LJd DAY OF 19� , NEW HOUSE SEWER
OWNER OR 6" CONNECT ADDITIONAL
OWNERS AGENT � P. BUILDING GP.WORK
ADDRESS - SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACK1tOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[I DRYWELL EDA
ND 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
-
- -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR .SEWAGE DISPOSAL SYSTEM
,
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
LDESCRIBED
IFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
RESIDENTIAL PROPERTY,
BACKFILL SEPTIC TANKS❑
/1 .SEEP. PIT(S) ❑ CESSPOOLS❑
NATURE 4
F PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,_CH1EF PLBG. INSPECTOR
_; 9 NJG23. 4 4.5 0