The URL can be used to link to this page

Home My Public Portal About5005 HELEO AVE_Sewer__ DEB°B '°.es TeneazD OPERMIT APPLICATION FOR � • COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. County Engineer ADDRESS WILLIAM A. JENSEN, Sup'1 of Building tj ry NEAREST NEAREST FOR APPLICANT TO FILL IN `ROSS ST. LEGAL �,..-� � / DESCRIPTION LOT NO. �� OWNER •GLV MAIL ' BLOCK TRACT /�i7 r� ADDRESS NO, OFBLOGS. 512E OF LOT NOW ON LOT CITY Jf1Y .y~ USE OF a��' DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS fjj/l f ��.[ BH PG CONTRACTOR �a//,r^�-T � �f��1 r � J_ / q ADDRESS 7 (.r ��j l;A /�j s' . / -CONNECTIONJDATA CITY j'' ,.J j: L. NO. �/-G / �;/ TION DEPTH 7 Iy-I, STATE / UPPER REGISTRATION NO. LJ COUNTY MANHOLE REFERENCE :Or ,L LOWER No. DESCRIPTION OF WORK FEEL J TYPE OF CON EC LENGTH FROM HOUSE SEWER CONNECTING TO Y. P.l,. M.L.TO P.L. PUBLIC SEWER ® $5.00 Y� 4,)(� O SEPTIC TANK,SEEPAGE PIT OR OB (J J PITS AND/OR DRAINFIELD 510.00 CO.IMP.NO. OB NO. \s V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, O PRIVATE DISPOSAL SYSTEM @ 53.00 CONNECT ADDITIONAL B L.G.OR AFFIDAVIT I WAIVEREASEMENT RECORD.INSTR_NO, DATL fW WORKTO HOUSESEWER 53.00 a OVERFLOW SEEPAGE PIT,DRAINFIELD h EXT N.,CESSPOOL.DRYWELL.MA N HOLE If SROO HWY.OR ST.WIDENING Z ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM S3.OD STATE ENCROACHMENT PERMIT NO, INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s z 00 CHARGES AUTHORIZATION TOTAL FEE D CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS _ TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE, SIGNED THIS DAY OF 19_ ) < . ,.� OA OWNER OR NEW HOUSE SEWER OW NERSAGENT CONNECT ADDITIONAL C BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PITIS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/Oft ALTER.REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CA LIFOgNl4 OR THAT IAM THE LEGAL OWNER�OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOrVV DESCRIBED RES ENTIn L"PROPERTY, ASIAN DON HOUSE BEW ER SIGNATURE /�� 7A /A �) / �• v BACKFILL SEPTIC TANKS ❑ OF PERMITTEE V �\ .,'�'fLf� '�-� SEEP,PIT(B) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. LA06 0-4 3 IG SEP 20 1 0 D 7.00- 7 TEMPLE CITY oro o,,2;— 2o CEaOae.ee APPLICATION FOR PERMIT seoe COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION AD ADDDRESSRESS o...'l ILDING JOHN A. LAMBIE, County En meer CASSATY D. GRIFFIN, Supt of Building LOCALITY Tc FOR APPLICANT TO FILL IN NEAREST CROSS ST. LEGAL �• DESCRIPTION LOT NO. ¢ OWNER /` BLOCK TRACT /33/� ! ADDRESS _— ;rs MAIL N0.OF BLDG$. SIZE OF LOT NOW ON LOT CITY X39 P _ 1. N0. USE OF BUILDINGS ULA/ DISTRICT NO. GROUP BK MAP PG /PROCESSED BY CONTRACTOR !� -51 I 91 ADDRESS / tG «cc1fLL++ CONNECTION DATA l/VV CITY TEL.NO.~ TATION ._ DEPTH ..��,�, //q STATE MANHOLE REFERENCE REGISTRATION N0. �7(/Y'� COUNTY —f LOWER NO. DESCRIPTION OF ORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ 43.00 TYPE OF CONN ION LENGTH FROM `7 SEPTIC TANK,SEEPAGE PIT OR Y. // P.L. M.L.TO P.L. J PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 PRIVATE D19POSAL$YSTEM TO @ $1.00 CO. IMP. NO. JOB N0. CONNECT OUSE ONALSEWS BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. s WORK C HOUSE SEWER @ EI.00 A LTER. REPAIR OR ABANDON SE STATE ENCROACHMENT SEWER OR DISPOSAL 5 TE / / @ SI.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REI MBURSEMENT 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 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 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 PLUMBING AND SEWERS. ALTER,REPAIR.SEWER OR 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 ABANDONCT PLUG AND CALIFORNIA OR THAT AM THE LEG ER OF THE ABO E HOUSE DESCRIBED RESIDEN L PROPER Y. BACKFILL SEPTIC TANKS [ISIGNATURE SEEP. PIT(S) D CESSPOOLS CI OF PERMITTEE Or _ VALIDATION ROBERT A. WOOD ..._ CA. M.o. CASH SUPERVISING MECHANICAL ENGINEER 0 4 3 2-2 SEP 2 0 1 1 D 2 '55.0.0' v