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Home My Public Portal About4913 HELEO AVE_Sewer__ 78A842D CE808 8.50 APPLICATION FO R PERMIT - COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUMDING AND SAFETY DIVISIONADDRESS' at�L-��O � MBIt JOHN A. LAIE, County Engineer CASSATT D. GIUFFIN, Supt of Building LOCALITYCROSS ST. C /f G it NEAREST �p ., .. .. FOR APPLICANT TO FILL IN .. LEGAL �p DESCRIPTION ; LOT NO. OWNER (/ U BLOCK TRACT MAIL ADDRESS N0.OF BLDGS. SIZE OF LOT ! OW ON LOT bAtg CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP - MAP PROCESSED BY CONTRACTOR y yyy I BK PG I ADDRESS '�alg f�1 CONNECTION ATA CITY -- TEL.NO. � STATION �L DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION NO. /N ® COUNTY _ NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 _ TYPE OF ECTION 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.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP, NO. JOB NO. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT NO., ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT - SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMT T 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE <I", REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEW R. SIGNED THIS Y OFLAAV © NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 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 pLTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND CALIFORNIA OR T A 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESID T AL PROPERTY. BACKFILL SEPTIC TANKS ❑ d SIGNATURE SEEP.PITS ❑ CESSPOOLS ❑ `� �'� G / G?'Kry OF PE, / ®" VALIDATIO ROBERT A. WOOD CIL M.0. CASH SUPERVISING MECHANICAL ENGINEER c7 .