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Home My Public Portal About4919 HELEO AVE_Sewer__ r � CE808 10-62 APPLICATION PP ICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ! / JOHN A. LAMBIE, County Engineer ADORE SS WILLIAM A, JENSEN, Sup't of Building i LOCALITY 11� ..�. NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL pp DESCRIPTION LOT NO. OWNER /dpl /.A MAIL BLOCK TRACT ADDRESS NO. OF SLOGS. SIZE OF LOT MOW ON LOT CITY TEL. NO. USE OF BUILDINGS E DISTRICT NO. GROUP4 MAP PROCESSED BY BK PG CONTRACTOR L f8 c)N 0 ADDRESS A, CONNECTION DATA � CITY (,!,`7( TEL. NO. STATION DEPTH P'� 'r / [( STATE C ( UPPER REGISTRATION NO, :219 �Y/ E) COUNTY MANHOLE REFERENCE t 6 d NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. J PUBLIC SEWER @ $5.00 (.Io P.C.NO. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. - PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD,INSTR.NO, D TE d WORK TO HOUSE SEWER @ $3.00 to OVERFLOW SEEPAGE PIT,DRAINFIELD Z EXT N.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S. PERMIT $1 21 00 CHARGES AUTHORIZATION I TOTAL FEE 1 7 16 J CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR N[ ,j NEW HOUSE SEWER ✓ OWNERS AGENT • `� ` n CONNECT ADDITIONAL SI BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINAN ES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPER R GISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED B LOS ANGLE COU TY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT i A THE LEGAL WNE OF, AND IN TO DISCONNECT PLUG AND RESIDE IN, THE AS VE SCRIBED RE EN A PROPERTY. ABANDON HOUSE SEWER SIGNATURE % BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER t 47 —�c JL 810 D .7.00!y v d r CE G4 10-82 A IanPII �C A Y°RoA1 ICOR PERMIT 78A 842D i�II�If�l� '�+F"� A II I\7 FOR I�IG If`( COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building / LOCALITY G'�.N. 'F NEAREST FOR APPLICANT TO FILL IN CROSS ST. f Cr u ,9 LEGAL DESCRIPTION LOT NO. v OWNER (/(/ �f / MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. -NO. ... .._,... ._cu .. .. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK /SPG CONTRACTOR tv �- � d C� ADDRESS ` ,e acc��7CONNECTION DATAppp```�� ry CITY ��.'(,a1 TEL. NO. a� / � j STATION � 0 / DEPTH � I"o SC STATE MANHOLE REFERENCE ge)(� �' ��[� UPPER REGISTRATION NO. ❑ COUNTY ceI — ' NO. GESCRIP ON OF WORK FEE TYPE OF CONNECTION LENGTH FROM r� a HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. O PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR J P.C.NO. �J ( PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. � HOUSE SEWER CONNECTING TOTRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 / CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAIVEN EASEMENT I RECORD.INSTR.NO. DATE 1V WORK TO HOUSE SEWER @ $3.00 0- OVERFLOW OVERFLOW SEEPAGE PIT,DRAINFIELD fn EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 Z ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM _ @ $3.00 STATE ENCROACHMENT 6. J PERMIT NO. INDUSTRIAL WASTE APPROVAL OVVNER"S PERMIT $ 99 CHARGES AUTHORIZATION I TOTAL FEE 0_" CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION . AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I- HEREBY CERTIFY THA/RIBED PROPERLY EG TERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BANGLES C NT AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AMGAL OWN R OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DE RESIDE IA R PERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL.SEPT IC TANKS OF PERMITTEE SEEP,PITS) ❑ CESSPOOLS ❑ LIDATION ROBERT A. WOOD -CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER LACO 3 4 7 ' jl1L 3 1 1 D 2 Jc,U 0 �C/