HomeMy Public PortalAbout4949 HELEO AVE_Sewer__ 1 EMPLE CITY 1��ryn''
CE808 8-59 APPUCATF6N FOR
COUNTY OF LOS ANGELES SEWER—SEWAGE .®DSPOSAL �,•
DEPARTMENT OF COUNTY ENGINEER -2 Ito
BUILDING AND SAFETY DIVISION BUILDING '
" ADDRESS �`���' �`+•�,
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup t of Building LOCALITYr '-
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"Fiffif-ml,tt_14911�- NEAREST
FOR APPLICANT TO FILE'IN caos3_ST.
LEGAL
DESCRIPTION LOT N0. -
OWNER '���
BLOCKTRACT ' s .'�,.�f MAIL �/`-_.'%/r.—!-/!�
�.�'.`.s ADDRESS �' >
SIZE OF LOTS- ✓�l�✓,t ; � NOW ON LOT CITY NO.OF TEL. NO
USE O F
BUILDINGS �`+�".:./'�" 1-%/!'�1''Y DISTRICT N0.I GROUP K MAP - PROCESSED BY
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CONTRACTOR -( ,. PJ fi� �� �•C-m"r .. ,�JrIJ !J I // /11)G✓ I
ADDRESS� �✓, CONNECTION DATA
CITY TEL.N0. ��"� r"" ST ON DEPTH
,;� _�`° ✓ ' STATE MANHOLE REFERENCL)7 UPPER
REGISTRATION NO. C.�.:,,.t fCOUNTY
-
NO. DESCRIPTION OF WORK _ FEE - -
HOUSE SEWER CONNECTING TO
qP PUBLIC SEWER C-4-3-00 TYPE OF CO MON LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR - i Y. P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW'SEEPAGE PIT,-DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO.
CONNECT ADDITIONAL BLDG.OR - l
WORK TO HOUSE-SEWER @ SI.00 }- TRUNKPER'MIT NO. OAD PERMIT N
ALTER, REPAIR OR ABANDON HOUSE STATEENCROAC'MENTf
SEWER OR DISPOS L SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S ' PERMIT $1 2 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE J REIMBURSEMENT FEE
LRE VE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON-
TOR TO CONNECT THE ABOVE DESCRIBED EXIST G DWELLING APPROVALS DTE /e INSPECTOR'S SIGNATURE
HE PUBLIC SEWER.ED THIS DAY OF19NEW HOUSE SEWER.ER OR CONNECT ADDITIONALERS AGENT BUILDING OR WORK
ESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELLSALL COUNTY ORDINANCES AND STATE LAWS REGULATINGALTER,REPAIR,SEWER OR
BING AND SEWERS. SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG ANDNSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CTPLUGHOUSE AND FORNIA OR THAT =l`'AM THE LEGAL OWNER OF THE ABOVE rRIBED RESIDEN L PROPERTY.r �:. BACKFILLSEPTIC TANKS ❑ATURE l �,�. �, EEP.PIT(S) ❑ CESSPOOLS
PERMITTE / / •• ��
®a ALIDATION ROBERT A. WOOD
M.0. CASH SUPERVISING MECHANICAL ENGINEER
,.p l 4. 2 SEP 13 1 '0 D
TEMPLE CITE'
I� 78A642D
caeos 8.59 APPLICATION FOR PERMIT 7
COUNTY OF LOS ANGELESJ.
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
< jam; ry
NEAREST _
FOR APPLICANT TO FILL IN CROSS ST. -
LEGAL IL OWNER I, .� -/ '.r.:"-•-
DESCRIPTION LOT N0.
BLOCK TRACT ` 'id' MAI L
ADDRESSNO.OF
SIZE OF LOTS-' °.''�I ��'� NOW ON LOTS "� CITY "`./fi=t NO.- � — "�-
USE OF
DI DISTRICT NO. GROUP MAP 70CESSED BY
BUILDINGS ��:- _ _ _ '�- �" Jl
" BK PG
CONTRACTOR�-- ', ,/ t
ADDRESS - ,y ,'` •,_ s"-'4 ',�" : ` CONNECT ON DATA
CITY TEL NO.,_ - .r NATION DEPTH --�
/y / /r. J�iq .'.
STATE MANHOLE REFERENCE - UPPER '
REGISTRATION NO. '� - "��* ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF ON £CTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $3.00 f
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00HOUSE SEWER CONNECTING
l _
PRIVATE DISPOSAL SYSTEM TO @ $1.00 CO.IMP. NO.
CONNECT ADDITIONAL BLDG.OR „�..,
WORK TO HOUSE SEWER '7 @ $1.00 TRUNK PERMIT NO. ROAD PERMIT N _ ,y
ALTER,REPAIR OR AB ON HOUSE STATE ENCROA MENT t
SEWER OR DISPOSAL STEM @ $1.00 PERMIT NO. - ' j -
��� INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE L-L• - REIMBURSEMENT FEE
DATE A CONTRACT WITH THE HEREIN NAMED CN-
TRACTOR TO CIONNE T THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I 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 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 OWNR OF THE ABOVE
DESCRIBED RESIDEN AL PROPERTY. BACKFILL SEPTIC TANKS ❑
./ SEEP. PIT(S) ❑ CESSPOOLS ❑
SIGNATURE , /� �;•�
OF PERMITTEE
OF ALIDATION ROBERT A. WOOD
C.,
9.0. CASH SUPERVISING MECHANICAL ENGINEER
lyd,o 0 1 4 3'%Q SEP 13 1 1 D 2 5.0 O N
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