HomeMy Public PortalAbout4840 HELEO AVE_Sewer__ 'i'76 A 642 D
' O R PERMIT
S 8 E-663 12.54 APPLICATION .
DIVISIONOF BUILDING AND SAFETY
SEWER-SEWAGE DISPOSAL
Departanent of County Engineer
County of Los Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
CRROSSOSSST
FOR:APPLICANTT�TO FILL IN N2FC
_ ST- /
LEGALi -1. � .` •�
DESCRIPTION LOT NO.� OWNE
BLOCK TRACT `; /r. MAIL
ADDRESS
�js y i NO.OF BLDGS.
SIZE OF LOT jf �j� a„g NOW ON LOT CITY s ;.. ry,, L TEL. N0. 5
USE OF
BUILDINGS /&-._x �//
1,111c1»(T�Z..O�-s'` DISTRICT NO. GROUP MAP -
i�� /�, _ ,yam• - BK PG
CONTRACTO �, "Y"�'..,�.,-• -�•'� ✓ /8/
ADDRESS = CONNECTION DATA o
1
CITY C, O, / - STATION DEPTH
%' ❑ STATE D g S� MANHOLE REFERENCE
REGISTRATION NO. - C3 COUNTY AcA" w3 1 UPPER LS,1�.B2
TYPE OF CONNECTION LENGTH FROM q9�
NO. DESCRIPTION OF WORK FEE .r.l CURB Pip M.L. TO P.L. aF
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER ' '@ $ 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 ` r
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N0. x�
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
S PECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWATER'S $ 1 00
AUTHORIZATIONT TOTAL FEE' - S( LIry
REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- 1
TRACTOR TO CONNECT THE ABOVE DESCR ED EXISTING DWELLING APPROVALS .DATE INSPECTORS SIGNATURE
TO THE PUBLIC35 WER
SIGNED THIS - DAY OF / -G!T+.� 19 NEW HOUSE SEWER
OWNER OR L / CONNECT ADDITIONAL !lliii..Y777
OWNERS AGENT �� �' BUILDING OR WORK'
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .CESSPOOL❑ 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL 'OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
=''r\7'(�L a ✓! "�'e SEEP:PITS) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE
mmom
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
- - _:)L05 11 31S •L12'7 4 4.50
,BY BY _ --
- DEPUTY DEPUTY
,BY BY n
.,`® DEPUTY DEPUTY