HomeMy Public PortalAbout5011 HELEO AVE_Sewer__ 76A 6420 - CE606 - 9/73'
AF I TION FOR P;�MIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY
NEAREST
PP LICA T TO FILL IN GROBB sT.
EDERIPTION:LOY
NO. f OWNER
MAIL
ACT Z— ADDRESS
NO. OF SLOGS. /� 'T NOW ON LOT CITY - (_� . TEL. NO `� [�
DISTRICT NO. GROUP MAPOCESSED BY
BK PS
CONTRACTOR D c��s C _/ U L
ADDRESS CONNECTION DATA
CIT SA TE /' EC NO. /J_ STATION /�.J OEPTM
LICENSE NO. ` xz' CL BBC MANHOLE DEFERENCE _/ c-�f1 g.0/ LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CO TIO T`� L`EINGTMFRJOM
HOUSE SEWER CONNECTING TO Y. M.L.TO P.L.
PUBLIC SEWER • $T.00
SEPTIC IANN.SEEPAGE PIT OR P.C.NO,
PITS qNO/OR DRAINFIELD ® f10.00 CO.IMP,NO, JOB NO, /�F
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PER IIL./ T/
PRIVATE DISPOSAL SYSTEM ® 63.00 IIC/ O J
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT uv[[ s[IIbT RECORD.INSTR. NO. DATE Y
WORK TO HOUSE SEWER 53.00 d
OVERFLOW SEEPAGE PIT.DRAINFIELD O
EXTN..CE5SPOOL.ORYWELL. Q $5.DO V
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR OISPOSAL SYSTEM ® S3.00 O
STATE ENCgOAC�S1sE �
MANHOLE ® S7.00 PERMIT NO. v / U
W
INDUSTRIAL d
WASTE APPROVAL N
Z
OWNER'S PERMIT s
CONNECTION CHARGE LEE CHARGES -
AUTHORIZATIONI TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TTO CONNECT THE ABOVE: %ISTING DWELLING
TOO THE THE PUBLIC B ECT APPROVALS O E INBP C fl'S I U E
SIGNED THIS DAY OF BE 19_
OWNEROR NEW HOUSE SEWER
OW NERSAGEHIT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(B)
HEREBY THAT
THE ABO THAT 1 HAVE READ THIS APPLICATION qN0/OR DRAINFIELD
AND STATE THAT TXE ABOVE IS
CORRECT AND AGREE E COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
FLUMBING AND SEWERS. CESSPOOL ❑ ORYW ELL ❑
I H BY CERTIFY THAT 1 AM PROPERLY REG TERED AND/OR ALTER.REPAIR.SEWER OR
LIC SED REOVIREO BY (OGLES DUN AND STATE OF SEWAGE DISPOSAL SYSTEM
CA NIA OR HAT I AM THE L O HER F. AN INTEND TO
RE IDE IN, TH A O ."CR
ARE E qTT. DISCONNECT PLUG AND
USE SEWER
SIGNA BACKFILL SEPTIC TANK$ ❑
OF PERMITTEE ❑
SEEP.PIT I51 ❑ CESSPOOLS
VALIDATION CK. M.O. cnsK
4 2 5�OCT 281 0 0 15 0 0 sae
v �
76A 6420 - CE808 - 9/73 APP LICATIO FOR PERM)
COUNTY OF LOS ANGELES SEWE -SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 0
ADDRESS
OCAL ITY
FOR APPLICANT TO FILL IN CROSSSSY
LEGAL
OESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRwC19 I Z 17 ADDRESS 7- 0 _
NO. OF BLDG$.
512E OF LOT NOW ON LOT CITY TEL. NO.Ay/
USE OF !
BUILDINGS DISTRICT NO, GROUP 'MPP ^ ESSED BY
BK Pi
�Y / \
CONTRACTOR
✓v� 2 1045 Q J
ADDRESSy22 CONNECTION DATA
STATION /'L t(`p DEPTH
CIT STATE /1 NO. _ ST Al
IC
LICENSE NO. ` ki
OL MANHOLE REFERENCE Z fJ-O
OWER
NO. DESCRIPTION-OF WORK FEE TYPE OF CONNECTION LE
HOUSE SEWER CONNECTING TO Y. CURB P.L. M,L.TO
PUBLIC SEWER ® $7.00
SEPTIC LANK,SEEPAGE PIT OR P.C.NO,
JOB NO.
PITS AND/OR DRAINFIELD ! SIO.00 CO.IMP.NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT p f^ 1
PRIVATE DISPOSAL SYSTEM ® $3.00 V'O, v
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT xAIYfE IAf[A[XT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER Q 33.00 y
OVERFLOW SEEPAGE PIT.DRAINFIELD V
EKTN..CESSPOOL.ORYWELL. Q $5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING C
SEWER OR DISPOSAL SYSTEM 13.00 STATE ENCROACHMENT
M A!!,qDL E
O $].00 PERMIT NO. W
INDUSTRIAL 1
WASTE APPROVAL y
Z
OWNERS PERMIT � CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THISDATE A CONTRACT WITH THE HEREIN NAMED 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_
OWNER ORA ��y� . NEW ECT ADDITIONAL OWNERS AGENT _
CONNECT A R WORK
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP.PIT(S)
HE
ACKNOWLEDGE 1 HAVE READ THIS APPLICATION qRO/OR GRAINFIELD
STATE THAT THE ABOVE
ICORRECT AND AGREE CO
WIT MPLY
WITH ALL COUNTY ORDINANCEE S S AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL [3DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR
LICEN AS REOVIRED BY LOS ANGLES COV TY AND STATE OF SEWAGE DI SPOSAL SYSTEM
CALL CANIA OR TMAT AM TX EGAWN OF, AND INTEND TO
R TXE wBOVE OES D 5ID IAL PROPERTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
IG BACKFILL5EPTIC TANKS ❑
OF EE
SEEP.PIT ISI ❑ CESSPOOLS ❑
VALIDATION CK, M.O. c>sx
424�pCT 283 () 0 30.00 � �