HomeMy Public PortalAbout4856 HELEO AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL, 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER i BUILDING 4R --SC, ����� Lt
ADDRESS
FOR APPLICANT JO FILL IN LOCALITY C,
BUILDING NEAREST
ADDRESS 4� ) S ,4 ��!� CROSS ST. ��f "-
LOCALITY,J, ,,,_A_f � A /// DISTRICT N0. SERIAL N0. PERMIT Nb.
NEAREST v!l�Lts(.p/ /6 _ /l' S A •���� S
CROSS ST,
_ RECEIVED BY Ready for Inspection DATE ISSUED
OWNER )_A
MAIL
ADDRESS /y+ USE ZONE OCCUPAkCY MAP
� �� /I ,% ,- � C?.;'.LqQ BK PG
CITY,Ihz Y� ✓.4:/ ��rn TEL.NO.4. 7�(-717� [A—\ _
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CONTRACTOR1� ,a? C.O.IMP.NO. I
ADDRESS JOB NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION N0. - COUNTY ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT -�
DESCRIPTION LOT N0. _PERMIT N0.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF
LOT y4 G�S� NOW ON LOTNO.OF S CHARGES
USE OF
DI �! � //}} CONNECTIO ARGE FEE
BUILDINGS r-E"'� 7 y'C_��
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 3 U RECEIPT NO. @A.I;E I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR /� EXCEPTION RECORDED~_--�,
WORK TO HOUSE SEWER 1.00
— ALTER OR REPAIR EXISTING NO. I DATE i BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER'
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR I
PITS AND/OR DRAINFIELD 2.00 STATION c -* 5 q DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �• MANHOLE REFERENCE
t .J Cl I �e LOWERS
TYPE OF CONNECTION LENGTH FROM
(Y CURB? SF'k- M.L.TO P.L.
OWNERS PERMIT $ I Go
AUTHORIZATION TOTAL FEE 4-1-5 0
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SXGNATURE DATE
DWELLING TO THE PUBLIC SEWER _
SIGNED THIS-•....._...........DAY OF....... ..............._......19..._.._ NEw HOUSE SEWER
OWNEROR yj ��0 CONNECT ADDITIONAL
BUILDING OR WORK
.D.W.b1E•RS A#'r@N•T...-�...._....._......_:.....--=-_.._.....-`•-...!�}�......._-
ADDRESSr SEPTIC TANK,SEEP.PIT(S)
-;7---„--•--^—.-•-•r--r �.rpt:__.............._._---:-:... --- ---' ' AND/OR DRAINFIELD
,
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLI- CESSPOOL[I DRYWELL El
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OFA CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERT�Y. BACKFILL SEPTIC TANKS
� �r SEEP.PIT(S)C] CESSPOOLS �.
SIGNATURE
P% 4�/�� � �
OF PERMITTEE._ V— ^--.......1•- = - �..=_.:__.�a ;'
r,
76A642A 663 7/53