HomeMy Public PortalAbout4935 HELEO AVE_Sewer__ APPUCATOO
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cseoe•e-se COUNTY OF LOS ANGELES l7 U Il
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING., L �y
JOHN A. LAMBIE, County F�gineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building LOCALITY / G /►' �L '� C l'� t'
....>. .:r -. .:nNEAREST -
a FOR APPLICANT TO FEL IN CROSS ST.
a LEGAL A� h
DESCRIPTION LOT NO. • OWNER /v
BLOCK TRACT 7 MAIL
- �s ADDRESS
NO.OF BLDGS. - - _
SIZE OF LOT Z O NOW ON LOT . CITY TEL.NO.
USE OF `� .:., ,..
BUILDI DISTRICT NO. GROUPMAP PROCESSED B
�U� BK P6
CONTRACTOR' . ) 10,5ADDRESS = 7CONNE,
/ CTION-DATA
'n CITY TEL.NO. ION DEPTH
STATE MANHOLE REFERENCE
na REGISTRATION NO. j� J �! � ,COUNTY
NO. DESCRIPTION OF WORK ' FEE {
S HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 -
TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT ORY, CURB P.L. ' M.L.TO P.L.
`PITS AND/OR DRAINFIELD @' $3.00 -
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
p; HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 t CO.IMP.:N0: JOB NO.
CONNECT ADDITIONAL BLDG.OR
ORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
W
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
I`
SEWER OR DISPOSAL SYSTEM, @ $1.00 PERMIT NO:
INDUSTRIAL
WASTE°APPROVAL
CHARGES
O.WNEWS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I C1-0 REIMBURSEMENT FEE .
fCJ+I�e !I
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE (1/Nc7SP0ErCTLO•R'SLS�IdG'NIATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. • ��Z� a � ��
SIGNED THIS DAY OF- L9_ NEW HOUSE SEWER
OWNER OR. CONNECT ADDITIONAL
' OWNERS AGENT ��` BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
' ADDRESS r� 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
r CALIFORNIA OR THAT I AM THE LEGAL .OWNER OF THE-ABOVE
i DESCRIBED RESIDE TI L PROPERTY. BACKFILL SEPTIC_,TANKS❑
SIGNATURE SEE PIT(S) ❑ -CESSPOOLS
OF PERMITTE '
a,.<-
®e . MVAMATION ROBERT, WOO
G& tl.G. Bii 'lSUF'E
CARVISING MECHANICAL ENGINEER
78A844D A PUCA 0 O®N FOR PERMIT
Cfi808.8-58
COUNTY OF LOS ANGELES SEWER—SEWAGE ®Q SPOSA L
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING L, a
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building LOCALITYNEAREST
�� C
�. FOR APPLICANT TO FILL IN
CROSS ST. d- C
LEGAL B
�. DESCRIPTION LOT N0. OWNER /1
BLOCK TRACT ) MAIL
/ ADDRESS /v
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY G TEL..NO.
USE OF w. __
BUILDINGS .��� � 1 DISTRICT N0.t GROUP u MAP P SSED BY
_ BK PG
CONTRACTOR'
J� O�
T
�a. ADDRESS ` r T CONNECTION DATA
CITY TEL.NO.j, O �a G�`}� T ION �® DEPTH r
G STATE MANHOLE REFERENCE `
REGISTRATION N0. A?5; P ? ® COUNTY
No. DESCRIPTION OF WORK' FEE l LowER-
a
HOUSE SEWER CONNECTING TO777
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P;L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00
u HOUSE SEWER CONNECTING TO - - P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0. JOB N0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0.` ROAD PERMIT N0.
ALTER, REPAIR OR ABANDON HOUSE _ STATE ENCROACHMENT'
SF
WT
OR DISPOSAL SYSTEM @ $ .00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OVMEWS PERMIT g r CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE C) REIMBURSEMENT FEE
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.
SIGNED THIS DAY OF fig_ NEW HOUSE SEWER
OWNER ORe / CONNECT ADDITIONAL'
OWNERS AGENT �� BUILDING OR WORK '
SEPTIC TANK,SEEP,PITS)
,. ADDRESS AND/OR DRAINFIELD _
1 r 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 ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
a LICENSED AS REQUIRED BY LOS ANGELES COUNTY,.AND STATE OF ABANDON HOUSE SEWER
y CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE NTI L ROPERTY. BACKFILL SEPTIC TANKS❑
-
SW.PIT(S) [ICESSP0
SIGNATURE0 ❑
OF PERMITTE
®F
VAMATIC0 ROBERT A.WOOD
gg m,g, Cpgg SUFERYlrING MECHANICAL ENGINSrR .
iio 4 0 1 9 JUL 25 1 1" p 2.5.00 � . .