HomeMy Public PortalAbout5606 HELEO AVE_Sewer__ '°"°"° APPLICATION FOR PERMIT
caaoa-°-sa COUNTY OF LOS ANGELES ,•
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 560Heleo
MB
JOHN A. LATE, County Engineer ADDRESS
CASSATT D. GRIFF•IH,Supt of Building LOCALITY Temple City
NEAREST broadway
FOR APPLICANT TO FILL IN CROSS ST.LEGAL T
-DESCRIPTION LOT NO, OWNER JOYlri • l''itz6erald
BLOCK TRACT MAIL e s a i ca Roa -
ADDRE
NO,OF BLDGS. t 7225
SIZE OF LOT NOW ON LOT CITY TEL. N0.
USE OF
BUILDINGS Res. DISTRICT NO. GROUP BK PG MAP �CESSED BY
.
CONTRACTOR -LJ- onstruction
AnD ssBleeker CONNECTION DATA
CITY SEL.N0. Em- 8 3024 STATION �•f• �� DEPTH
STATE UPPER
REGISTRATION NO. B COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 3 TYPE OF CONNECTION LENGTH FROM
PETS AND/PTIC OR ORAENFIIELD PAGE T OR @ $3.00 -CU P.L. M.L.
TO P.L. 7
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOO L.DRYWELL.MAN HOLE @ $2.00C.Np
PRIVATE DISPOSAL SYSTEM HOUSE SEWERCONNECTING TO @ $I.OD CO.IMP.NO. JOB N0� �� J
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $I.00 TRUNK PERMIT NO. ROAD PERMIT N0.
SEWER OR DISPOSAL SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL - -
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ E p0 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS-DA 19 NEWHOUSESEWER .-I%•lA 4b�llp
OWNER OR 1V L' CONNECT ADDITIONAL. $
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR pISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM TN GAL OWNER OF THE ABOVE
DESCRIBED RESIDENT PROP Y BACKFILL SEPTIC TANKS T(PITS) E] CESSPOOLS E]SIGNATURE
OF PERMITTE -L- '�
VALIDATION ROBERTA.WOOD H.0. CASH SUPERVISING MECHANICALENGINEER
"r,o,o 9 3 2 0 iLiY 18 1 0 A 5.0 0 <`