HomeMy Public PortalAbout4903 HELEO AVE_Sewer__ IDEPA1trM[EENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
k. WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FBUILDIN ,�JO�R. APPLICAANT TO FILL IN LOCALITv
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ADDRESS /U�/YIIJ.t�C/[ f�_1ab�Z��✓�/ CROSS ST. vY Aa7-41S-4-
LOCALITY �vg/ya � ate- > DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST _ fy 6/ A 4 ?,;Xrjlf`�
CROSS ST.
OWNER !) fuJ_�r� RECEIVED BY Ready for Inspection y� DATE ISSUED
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MAILS[�� N �+ USEZON7Eq OCCUPANCY r MAP
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CITY TEL.NO.��z
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CONTRACTOR / CO.IMP.NO.
ADDRESS `q JOB NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. H COUNTY ROAD PERMIT NO. '
LEGALl— a� 'I �� STATE ENCROACHMENT
DESCRIPTION LOT NQ. ;,, / PERMIT NO. -
BLOCK TRACT `&� ���3��.�7 INDUSTRIAL
_ WASTE APPROVAL
SIZE OF LOT y NO.OF BLDGS. /
'S. � ' NOW ON LOT /�,Q y(.<ir CHARGES
USE OF /fes
BUILDINGS (/ CONNEC N CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMEN E
PUBLICSEWER @ $ 3.50 RECEIPT NO. ATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
pp CONNECT ADDITIONAL BLDG.OR EXCEPTION RECOWkED
y' WORK TO HOUSE SEWER ' 1.00
ALTER OR REPAIR EXISTING
NU-I DATE Y
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
a AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA -�
SEPTIC TANK,SEEPAGE PIT OR `�
PITS AND/OR DRAINFIELD. 2.00 STATION �7 3< DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ��++ l MANHOLE REFERENCE -
%�/ .Yi+r UEPERy LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT # 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 9 ®D
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF....................................... 19...-.- NEW HOUSE SEWER - 4 �� y"
OWNER OR CONNECT ADDITIONAL r
OWNERS AGENT........................................................................._ BUILDING OR WORK .noi G.S•
ADDRESS---------------------------------------------------------------------------------------------- SEPTIC TANK,SEEP.PITS) l
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL[-] DRYWELL
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SEEP.PIT(S)� CESSPOOLS
SIGNATURE � '
OF PERMITTEV.2-!�N11ot _--......_ 1f 11! !il...-.--_--••...
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