HomeMy Public PortalAbout4846 HELEO AVE_Sewer__ p24650 INSER I �D -
76A642D60 AP1�U CAT ®N FOR POE I1 11 M O .
COUNTY OF LOS ANGELES SEWER—SEWA0 DOSPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY LDIN
ADDRSG /•`
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building r`
I LOCALITY
r. >, _.... . NEAREST -
will
FOR APPLICANT TO FILL IN caoss sr. S'
LEGAL OWNER cc
DESCRIPTION LOT NO. '
BLOCK TRACT MAIL s
_ADDRESS
/• (�
NO.OF BLDGS. '
SIZE OF LOT NOW ON L T CITY TEL. NO.
USE OF 614
�J DISTRICT NO. GROUP ^vMAP ' PROCESSBY
BUILDINGS BK PG I
CONTRACTOR �^� ..d V,
ADDRESSi� CONNECTIONS DATA
CITY / TEL.N0. �,� ,7 STATION DEPTH
/ STATEMANHOLE REFERENCE - -UPPER
REGISTRATION NO. •V COUNTY - LOWER
No. DESCRIPTION OF4VORK F E
HOUSE SEWER CONNECTING TO Q 6�0
PUBLIC SEWER Co) $3.00 TYPE OF CONNECTION LENGTH FROM.
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L M.L.TO P.-L.-
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO "----_--— -P:C.
PRIVATE DISPOSAL SYSTEM @ $1.00 -C P. NO. JOB N a
CONNECT ADDITIONAL BLDG.OR z TRUNK PERMIT NO. ROAD PERMIT NO. V
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR O R ABANDON SYSTEM HOUSE @ $1 OO STATE ENCROACHMENT -
PERMIT NO. O
'INDUSTRIAL U
WASTE APPROVAL M
CHARGES
OWNER'S PERMIT $ 1 21 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEEINAMED CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS—AD 19_ NEW HOUSE SEWER
. OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ' BUILDING OR WORK r•^'
ADDRESS - SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORD ANCES AND STATE LAWS REGULATING pLTER,REPAIR,SEWER OR
PLUMBING AND SEWERS - SEWAGE DISPOSAL SYSTEM
I HEREBY
CELT.
AT 1 AM PROPERLY REGIS RED AND/OR DISCONNECT PLUG AND
LICENSED ABY LOS ANGELESCOUNTY ND STATE OF ABANDON HOUSE SEWER '
CALIFORNIA AM THE LEG OWN R THE ABOVE p
DESCRIBED PROPERTY. // BACKFILL SEPTIC TANKS ❑SIGNATURE y� ✓ ��—+ SEEP.-PITS) ❑ CESSPOOLS Cl
OF PERMIT
®F • VALIDATIOr ROBERT A. WOOD
CK. M.o. CASH SUPERVISING MECHANICAL ENGINEER
8 4 6 1 zD sE�rJ � 3 .1 U A 3.0-0 �-
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76A642D6O !/'1 PPUCt/�'6T�®N. FOR PERM IL COUNTY OF LOS ANGELES ���/��—���/�� ®���®�
DEPARTMENT OF COUNTY ENGINEERR, z�.,;. .<F,,
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Enq ineer ADDRESS (o
WILLIAM A. JENSEN, Supt of Building LOCALITY s
NEAREST
FOR YAPPLICANT TO FILL IN CROSS ST. S
LEGAL �� � ,
DESCRIPTION LOT N0. OWNER _ A:
BLOCK TRACT z ADDRESS
U MAIL ..0
NO.OF BLDGS.
SIZE OF LOT NOW ON L T CITY TEL. NO.
USE OF
BUILDINGSzltY DISTRICT NO. GROUP MAP PROCESS BY
BK PG I
CONTRACTOR
ADDRESSVf7CONNECTION DATA
CITY _ TEL.N0. ,7'�� STATION DEPTH _
STATE MANHOLE REFERENCE - UPPER
t4 REGISTRATION NO. V " COUNTY LOWER
NO. DESCRIPTION OF JVVORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF-CONNECTION LENGTH FROM _
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L, M.L.TO'P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.
PRIVATE DISPOSAL SYSTEM @ $1.00 b SUP. NO. JOBB
N W
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. - O
WORK TO HOUSE SEWER @ 51.00 V
ALTER, REPAIR O R BANDON SYSTEM HOUSE @ $I 00 STATE ENCROACHMENT - 07
PERMIT NO. EO+
INDUSTRIAL U
WASTE.APPROVAL a -
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTIJNGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. -
` SIGNED THIS D 4 19_ NEW HOUSE SEWER
OWNER OR ,- CONNECT ADDITIONAL "
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - - - ^
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ,. CESSPOOL ❑ DRYWELL ❑ '
WITH ALL COUNTY ORD ANCES AND STATE LAWS REGULATING ". ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTI AT I AM PROPERLY REGIS RED AND/OR DISCONNECT PLUG'AND _
LICENSED AS RE BY LOS ANGELECOUNTY ND STATE OF w_ ABANDON HOUSE SEWER '
CALIFORNIA OR T I AM THE LE—' OWN R THE ABOVE a
DESCRIBED RE D L PROPERTY. �(�/ '. BACKFILL SEPTIC TANKS Cl
SIGNATURE ✓' ��+ SEEP..PIT(S) ❑ CESSPOOLS ❑
OF PERMIT
c x
®F VALIDATIOP ROBERT A. WOOD
CK. M.0, CASH SUPERVISING MECHANICAL ENGINEER