HomeMy Public PortalAbout5600 HELEO AVE_Sewer__ E808.0
CAPPLICATION FOR PERMIT
eaoeaBe COUNTY OF LOS ANGELES -
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION euuDlxc 5600 eleo.
JOHN A. LAMBIB, County Engineer ADOft E55
CASSATT D. GRIFFIN. Supt of Building LOCALITY - emp e 1
NEAREST
FOR APPLICANT TO FILL. IN CROSS ST,
LEGAL
DESCRIPTION LOT No. 11 OWNERJohn t{. Fitzgerald
BLOCKTRACT 25202 AMAIL
DDRESS .21121 Mesa Rica Road
NO.OF BLDGS. Covina ED 2-'7925
SIZE OF LOT n NOW ON LOT CITY TEL.NO.
USE OF Ies.
BUILDINGS DISTRICT 110. GROUP MAP PROCESSED BY
BK PG
CONTRACTORL. D. & Mi Construction C
ADDRESS 5136 No. le6eker - CONNECTION DATA
CITY a win Park TEL. 10. Bi) -7024 STATION S`JLO- .1 DEPTH _
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION .LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTH.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TOC.
NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
SEWER OR DISPOR ABANDON OSAL SYSTEM HOUSE @ $I 00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT f 2 00 CONNECTION CHARGE FEE
_ AUTHORIZATION I TOTAL FEE 51 &-0 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE 1 SPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS ^Ay OF 19_ NEW HOUSE SEWER �'� •1/ti!}A
OWNER OR CONNECT ADDITIONAL I
OWNERS AGENT NEIN BUILDINGORWORK
-
SEPTIC TANK,SEEP, PIT(B)
ADDRESS 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,SEWER OR
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 AM T GAL OWNER OF THE ABOVE
DESCRIBED RESIDEN PRO T - BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PITS ❑ CESSPOOLS
OF PERMITTE '"'u
®e /--WF.L X.
0. SING MECROBERT A.A WOOD
CK. R.v. CASH SUPERVISING MECHANICAL ENGINEER
L�,wO93 1.01. 8 1 0 A 15.00