HomeMy Public PortalAbout4912 HELEO AVE_Sewer__ S&E-66311.55 APPU`/ATM.. " FOR Il PEI! l1MT lit
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DOSPOSAL o[L�al
Department of County Engineer "''
County of LOS Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY, /�1.•.M���
FOR APPLICANT«, r
TO FILL IN ceoss s. El
" LEGAL
DESCRIPTION LOT NO. oG OWNERMAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS. CITY yf- TEL. NO. i '
4
SIZE OF LOT NOW ON L T
USE OF DISTRICT NO GROUP MAP
BK PG
' BUILDINGS
CONTRACTOR
CONNECTION DATA
ADDRESS _
CITY TEL. NO. � � STATION DEPTH
MANHOLE REFERENCE - O UPPER
Cq STATE
REGISTRATION N0.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO q TYPE OF NECT N LENGTH FROM
PUBLIC SEWER @ $3.50 - Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD. - @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P.
C. NO. '
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. J' (� JOB NO.
_HOUSE SEWER.CONNECTING TO - �� `/'J'
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. - ROAD PERMIT NO. L Z
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWERtQ $1.00 PERMIT NO.
t. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL .
SEWER OR DISPOSAL SYSTEM Q $1.00 - WASTE APPROVAL '-
e
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THISDATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS _ DATE INSPECTOR'S SIGNATURE
TRACTOR'TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. ,�j.,,, NEW HOUSE SEWER `;
SIGNED THIS DAY p
DAY OF ` � 41V' 19�
y, CONNECT ADDITIONAL
OWNER OR1> � �`- y BUILDING OR WORK
OWNERS AGENT �6/ c'// ��..t/ `SEPTIC TANK,SEEP,PIT(S)
ADDRESS �d• �'.^._ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
/
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE :'
DESCRIBED RES]DENTIAL'PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE S ,'; SEEP. PITS) ❑ CESSPOOLS _
OF PERMITTEE s
JOHN A. LAMBIE, COUNTY ENGINEER , - ALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK.,,/ M.0.. 'CASH
C , 4 0 8 4'U'O) MAR 15 4 4.5 U
:rte-
/� 1�I� q /�C'�fii �{o FOR I�{�Cr�f�
5&E-6D All 0 LICU-'11TI811 �1 11 ®R tl E Rll tlW I 11
S&E-665 11.55
DIVISION OF BUILDING ARID SAFETY SEWER—SEWAGE D O S POSH L
Depccrt2nent of County Engineer
County of Los Angeles BUILDINGSS'
JOHN A. LAMBIE, COUNTY ENGINEER ADDRE / d
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN IR sT. l'
LEGAL 1 'I p, OWNER DESCRIPTION LOT N0. 7 '
MAIL
t BLOCK TRACT13 34
ADDRESS '
_ NO. OF BLDGS.
SIZE OF LOT KQ �( '.2:S �-NOW ON LOT CITY TEL. NO. +'
USE OF
BUILDINGS DISTRICT NO GROUP MAP
'
BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
' -y
CITY TELN0
L. . STATION �p - DEPTH �/ -
�.Yl�zfi ,L3� MANHOLE REFERENCE 1 UPPER
e STATE 0G R
REGISTRATION NO. �(ij ❑ COUNTY : L '
NO. DESCRIPTION OF WORK FEE " /I -/c" - "u-fA OF Upp,-, /,,14-4W(c
HOUSE SEWER CONNECTING TO TYPE OF E TION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. R , --
P.L. M.L.TO P.L. as_
SEPTIC TANK,SEEPAGE PIT-OR ( //
PITS AND/OR DRAINFIELD _@ $3.00 '�,� j-1! ��
OVERFLOW SEEPAGE PIT, DRAINFIELD - P. C. N0.
EXTN•,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. �. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0: ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER@ $ 00 - � PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL '
CHARGES
' CONNECTION CHARGE FEE
OWNER'S PERMIT $ OO
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE o
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- :° - APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF �V' e_/L 19� `
! CONNECT ADDITIONAL ��/j,�•� y '
OWNER OR �]{ � BUILDING OR WORK
OWNERS AGENT____�G; GC
// - SEPTIC TANK,SEEP, PIT(S)
ADDRESS _ i° AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 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 P�ROOJPE iTY' BACKFILL SEPTIC TANKS❑
SIGNATURE -elaee , 7" SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITTEE '
JOHN A. LAMBIE. COUNT ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. U.0. CASH -
bti.:;3 9 5 7 7 MAR 14 1 `) D '7 .00 m