HomeMy Public PortalAbout5608 HELEO AVE_Sewer__ T°Aa"°
QEeoa-a-ns APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION ADDRESSG 5608 xeleo
TOHN A. LAMBIE, County Engfnser
'CASSATT D. GRWFIN, Supt of Huildiaq LOCALITY 2'emple City -
NST
FOR APPLICANT TO FILL IN crossROSSsr. roaway
LEGAL
DESCRIPTION LOT NO. OWNER John R. Fitzgerald
BLOCK TRACT25202 MAIL 21121 Mesa Rica Roac
ADDRESS oo V _11 2-7925
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL.N0,
USE OF
BUILDINGS Res. DISTRICT NO.1 GROUP MAP PROCESSED BY
PG
CONTRACTOR TJ• 1M. onstructi on BK
ADDRESS o.. ee er CONNECTION DATA
CITY Baldwin Paul; E
EL. NO. STATION. t�V DEPTHSTATE G "\
REGISTRATION NO. COUNTY MANHOLE REFERENCE 2
NO. DESCRIPTION OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® $5.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR GRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.OC.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER 4D $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM a $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I LS HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. 'APPROVA -DATE INSP CTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �J
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19—
OWNER OR CO N NECT ADDITIONAL
OWNERS AGENT NAIW BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
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 TI
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT 1 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 THFITTGAL, OWNER OF THE 404OVE
DESCRIBED RESIDEN PROP BACKFILL
PIT(SEPTIC TA KS OTILS❑
SIGNATURE wL
OF PERMITTE
®f ALIDATION - 'ROBERTA.WOOD
CK. Y.o. GSH 'SUPERVISING MECHANICAL ENGINEER
Di109312 81 0 A 5 .00