HomeMy Public PortalAbout5006 HELEO AVE_Sewer__ CEBDB 3 6 APPLICATION FOR PER IT
TBAB42D;.
COUNTY OF LOS ANGELES SEWER-SEW E DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A. LAMBIE. County Engineer ADDRESS VBDI�
WILLIAM A. IENSEN, Supt of Building
LOCALITY
NEAREST
FOR APPLICANT TO FML IN CRO55 $T �C�+tCCT(L Z �-
EGAL .TI '/J
DESCRIPTION LOT NO.'S / OWNER f` p ��C1� e�/�/�
/ / fes_ MAIL �l/ M / Ki0 ?. ZVrA Y
BLOCK TRACT ADDRESS
No. OF LOGS. /J
SIZE OF LOT NOW OW LOT CITY TEL. NO. �• Z 06
USE OF
BUILDINGS £ / ' (Y C DISTRICT gI GROUP MAP Pq OCE55�Ep-B(Y
RD
CONTRACTOR f `J,O(J l BK /O SC- / S
ADDRESS ✓. '��C,' f' ✓r _ CONNECTION DATA (�
CITY yJ J �J CIryy TEL. NO _ O�q/Fy� STATION Z*"7 , C DEPTX 8
REGISTRATION NO. l/O •�/ lJ STATE UPPEW
COUNTY MANHOLE REFERENCE O p " 11 OWER
3 /(! r/A
NO. DESCRIPTION OF WORK FEE PE OF CONNEGWON LENGTH FROM
HOUSESEWEfl CO NNECTING TO Y. � p �I(g P.L. M.L.TO P.L. � S
PUBLIC SEW ER ® E5.00V
SEPTIC TANK.SEEPAGE PIT OR ) A I / JOBP.0NO.
PITS ANO/OR GRAINFIELD 510.00 30B NO. (� I
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. % /(,/
PRIVATE DISPOSAL SYSTEM ® 53.00 -_JJO
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAnu usu[ RECORD.INSTR,NO, DATE
WORK TO HOUSE SEWE R 53.00
OVERFLOW SEEPAGE PIT.DRAINFI CLD E XTN..CE55POOL.DRYWELL.MANHOLE@ 55.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR p IBFO.L SYSTEM 53.00
STATE ENCROACHMENT
PERMIT NO.
IN
VSTRIAL
WASTE APPROVAL
OWNERS PERMIT 5 z o0 CHARGES
AUTHORIZATION TOTAL FEE D D CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HE .IN
Nw MED CON" ,W #Fe
/7
TRACTOR TO CONNECT THE ABOVE DESCRIBED LISTING OW FEEING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGN TORE
SIGNED THIS DAY 19_ Y �
OWNER OR NEW MOUSE SEWER
OW NERS AGENT_ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP.PITIS)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AMU STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORO INAN ES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
HEREBY CEflTIFY TH4T AM PROPEflLY REGISTERED AND/OR ALTER. REPAIR.SEWER OR
LICENSED AS REOVIRED LOS ANGLES COUNTY AND TATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA Ofl THAT M THE LEGAL
OWNER OF. AND.
NTEND TO DISCONNECT PLUG AND
RESIDE IN. THE A DESCRIBED RESIDENTIAL RO RTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMRTEE SEEP.PITIS) ❑ CESSPOOLS ❑
ALIROBERT A. WOOD
M..0.o. C cases SUPERVISING MECHANICAL ENGINEER
L11LO 9 3 1 6-� JAN 17 1 0 D 7,00,"
DE$DB 3-62 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUIL NG EL��
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CflOA. ST GID
LEGAL
DESCRIPTION LOT NO. OWNER
/ MPIL le 31-3-.-Z"(!
BLOCK TRACT ADDRE$
NO.AF BLOCS. L.
SIZE OF LOT TNOW ON/:OT�\ CITY TEL. NO. OZ
OF
BV ELDINGS
DISTRICT NO. GROUP MAP PROCESSED BY
PG G T�
CONTRACTORV C S O O T 4—
ADDRESS j ��%f/ Y• J/�ry-� -j��� CONNECTION DATA
CITY --� TEL. NO/� rlSTATION l ,3, O DEPTH
PPER
REGISTRATION NO. ?
^ B COVNTY ST MANHOLE REFERENCE -9- 3 /l/0J0 OWE
NO. DESCRIPTION OF WORK FEE T'�P[OF=N CEION LENGTH FROM [�
HOUSE SEWER CONNECTING TO Y. :]H D A1Rr- P.L. M.L.TO P.L. •J I}
PUBLIC SEWER $5.00 0
P.C.No.
SEPTIC TANK.SEEPAGE PIT OR ( 4 JOB NO.
G V
PCO. MP. NO. I ITS ANO/OR DRAINFIELD s10.00 I
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00 / Yl
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIV[A EASIKENE RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER ® $3.00
OVERFLOW SEEPAGE PIT.GRAINFIELD
EXTN..CESSPOOL.DRYWELL.MANHOLE Q $5.00
ALTER.REPAIR OR ABANDON HOUSE' H WY.OR ST.WIDENING _
SEWER OR DISPOSAL SYSTEM ® 53.00 STATE ENCROACHMENT
PERMIT NO.
INDUS
RIAL
-AST.APPROVAL
APPROVAL
OWNERSI PERMIT Sl 2, cc CHARGES
CONNECTION CHARGE FEE -
AUTHORIZATION TOTAL FEE � _
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- AU/7
TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGNATURE
SIGNED THIS-DAY OF 19
OWNER OR 6� _ NEW HOUSE SEWER
OWNERS AGENT_ Gr CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TA DRAIRAINFIEL PIT(5)
ND�OR NFID
AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY
ORDINANCES AND STATE LBWS REGULATING ❑
PLUMBING AND SEWERS. CESSPOOL ❑ °RYWELL
1 HEREBY C Y T T AM PROPERLY flEG ISTERf ANpI OR ALTER,REPAIR,SEWER OR
LICENSED RE°UIRE 0Y LOS ANGLES COUNTY AN( STATE OF SEW
AGE DISPOSAL SYSTEM
CALIF0 OR THAT AM THE LEG OWNER AN INTEND TO °I$CONNECT PLVG AND
RESID THE w VE DESCRIB A IGEN AL FR ERTY. ABANDON HOUSE$EWER
SIGN ❑
OF P TTEE BACKFILL SEPTIC TANKS
SEEP.PIT IS) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CASH SUPERVISING MECHANICAL ENGINEER
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