HomeMy Public PortalAbout4929 HELEO AVE_Sewer__ -mow
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PERMIT
EMIT
COUNTY OF LOS ANGELES SEWER-SE GE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING - ,/ •
ADDRESS
LOCALITY
_. .,,..,. NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL •.a
DESCRIPTION LOT NO. OWNER
12.1
!y / S_/
MAIL
BLOCK TRACT 9 ADDRESS
NO. OF BL G5.
SIZE OF LOT NOW ON LOT CITY TEL. NO. c e
USE OF DISTRICT NO. GROUP MAP ACIIIED BY
BUILDINGS _
BK /P G
CONTRACTOR !,�/�0
ADDRESS -�? z ��� y� CONNECTION DATA '^
CITY Gr9f1j(�P� TEL. NO. �(./ STATION 1,0- .41 DEPTH v.�•�
STATE LIC
LICENSE NO. CLASS MANHOLE REFERENCE 7''yyy�x
NO. DESCRIPTION OF WORK FEE TYPE OFC NECTION / LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CUR P.L. M.L.TO P.L.
PUBLIC SEWER @
SEPTIC TANK.SEEPAGE PIT OR P.C.NO.MPNOJOB NO. d
PITS AND/OR DRAINFIELD @ Co.. . . /V O
HOUSE SEWER CONNECTING TO U
PRIVATE DISPOSAL SYSTEM @ TRUNK PERMIT NO. ROAD PERMIT NO. /}
CONNECT ADDITIONAL BLDG.OR , AFFIDAVIT I wAIVEN EASEMENT RECORD, INSTR,NO. DATE
WORK TO HOUSE SEWER @ O
OVERFLOW SEEPAGE PIT.DRAINFIELD F
EXTN..CESSPOOL.DRYWELL.MANHOLE_@ W
ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING d
SEWER OR DISPOSAL SYSTEM @ STATE ENCROACHMENT h
PERMIT NO. z
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ -300 1
AUTHORIZATION I TOTAL FEE 1006 CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONS REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS
ALS 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. T(5)
I HEREBY ACKNOWLED EAD THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT T.HE ABOVE IS CORRECT NO AGREE TO COMPLY
WITH ALL 5P,11'IC1TY ORDINANCES AND S ATE LAWS REGULATING CESSPOOL ❑ DRYW ELL [IPLUM BINAND SEWERS.
I HEREBY CE TI' THAT I A OPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED R OUI F�.p-B ANGLES COUNTY AND STATE OF SEWAGE DI SPOSAL SYSTEM
C 61`( [R I M LEGAL OWNER OF, AND INTEND TO
g' ���{{{ {�g� DISCONNECT PLUG AND
SIGNATURE PROPERTY. ABANDON HOUSE SEWER
Y BACKFILL 5'EPTIC'7A;,, S�J
SES-P_IT4S):=Q CESSPOOLS P
RE0 Mrr EE A V ScSC D RESI,DYN SIAL PROPE
11 ALIDAT-- � •P
C M. CASH
9"!0 1,r--MAR 1 1 V rD 1 0.0 0 A