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Home My Public Portal About5007 HELEO AVE_Sewer__ E041 a-5o° TEMPLE COTY c8APPLICATION FOR PERMIT -5-007 so'� COUNTY OF LOS ANGELESy SEWER-SEWAGE DISPOSAL, 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS e jGRN A. LAMIE; County Engine CASSATTD. GRIFFIN, Supt of Buil er ` NEAREST FOR APPLICANT TO FILL IN CROSS s LEGAL �! OWNER DESCRIPTION LOT N0. �/' BLOCK TRACT /3.��9 MAIL /' sENO... ADDRESSNO.OF SLOGS. SIZE OF LOT NOW ON LOT CITY TE USE I DISTRICT N0. GROUP MAP PROCESSED BY BUILD INGS �.(/�i/JJ7 � ( ,.I r�-I� BK PG CONTRACTOR X I 1 I J_ J'-. .T I ADDRESS 7� 1 «`JJ-Y�- CONNECTION DATA 1K- CITY TEL.N0� ATION _, . J DEPTH �} STATE MAN HOLE REFERENCE REGISTRATION NO. IQD 3L!/f� COUNTY LOWER NO. DESCRIPTION OF WORK FEE - HOUSE SEWER CONNECTING TO PUBLIC SEWER TYPE OF CONNE ON LENGTH FROM fq / SEPTIC TANK,SEEPAGE PIT OR Y. _ CU P.L. M.L.TO P.L. J .J PITS AND/OR DRAINFIELD @'$3.00 _ OVERFLOW SEEPAGE PIT, DRAINFIELD EKTN_C ESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO J/ P.C.N0. PRIVATE DISPOSAL SYSTEM @ SI.00 CO.IMP. NO.. ��/ (- JOB NO. CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT N0. ROAD PERMIT NO. _J WORK TO HOUSE SEWER @ $1.00 ' SETER,REPAIR OR LSYST EM HOUSE @5100 STATE ENCROACHMENT' PERMIT NO. INDUSTRIAL WASTE PPROVAL CHARGES OWNERS PERMIT s 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE 1 71 ino REIMBURSEMENT FEE 1 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 -,T� SIGNED THIS DAY OF 19_ NEW HOUSE SEWER Il .i � ✓•:'LL OWNER OR CONNECT ADDITIONAL '• ` v OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(5) AND/OR GRAINFIELD 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 I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOOSE SEWER CALIFORNIA OR THAT 1 AM THE. LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN5Wf PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS ❑ OF PERMITTEE ®r /—)VALIDATION ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER LA;u0.4.3 3 SEP.2O 1 O 'D 7.00" .9 TEMPLE CO`i Y CESM e.nn APPLICATION FOR PERMIT f- 1 eeae COUNTY OF LOS ANGELESIC i SEWER—SEWAGE DISP SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING ADDRESS ]OHN A. LAMBIE. C..tF En eer CASSArr D. GRIFFIN, Supt of Building LOCALITY ep NEAREST EDESCRIPTION PPLICANT TO FILL IN cnoss sr. OWNER 0. T / MAIL pADRE55NO.OF BLOCS. NOW ON LOT CITY TEL. NO. DISTRICT NO. GROUP MAP PROCESSED BY BK PG CONTRACTOR �➢ U - ADDRESS f , ® CONNECTION DATA CITY�r TEL.N0. ST TION DEPTH STATE MANHOLE REFERENCE REGISTRATION N0. �(p COUNTY I LOWER J NQ. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OFC TION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. / P.L. M.L.TO P.L. PITS AND/OR DRAINFIELO @ S3.00 _ OVERFLOW SEEPAGE PIT. DRAINFIELO EXTN.'.CESSPOOL.DRYWELL @ S2.00 HOUSE SEW ER CONNECTING TO P.C.NO. PRIVATE OI SPOSAL SYSTEM @ SI.00 CO.IMP. N0. JOB NO. WORK CT ADDITOUSEIONALSEWELDG.OR @ $1.00. TRUNK PERMIT NO. ROAD PERMIT NO. TO ALTER,O PAIR OgA9 NTO j USE @ $I 00 STATE ENCROACHMENT PERMIT NO. �- INDUSTRIAL WASTE APPROVAL _ CHARGES OWNERS PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE IHAVETRACTORA TO CION N ECT THE ABOVE DESCRIBED EXISTIINGDATE A CONTRACT WITH THE HEEINAMED 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 ADORES S SEPTIC TANK,SEEP.PIT(5) 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,SEWEROR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I 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 MTHE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT[ OPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS OF PERMITTEE aF VALIDATION ROBERT A. WOOD CIL M.o, DAstl SUPERVISING MECHANICAL ENGINEER LACOO 4 3 4t2 SEP20 1 1 D 2 5,00