HomeMy Public PortalAbout5609 HELEO AVE_Sewer__ T°A°'a°
C11608-a-58APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING FA Heleo
JOHN A. IAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building LOCALITY emple City
NEAREST nfoadway
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. 13 OWNER John R F'
BLOCK TRACT 25202 MAIL
ADDRESS 21121 Mesa Rica Road
NO.OF BLDGS. -� C
SIZE OF LOT NOW ON LOT CITY Quina TEL. NO. D 2
USE OF
BUILDINGS Res. DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR
ons ruc lon � BK PG
ADDRESS 513C5 No. Bleeke::L CONNECTION DATA
CITYBaldwin Park TEL. NO. ED H-3024 STATION S�-6 DEPTHSTATE \
REGISTRATION NO. COUNTY MANHOLE REFERENCE UPPER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 4
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.
b
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
WORK C H ADDITIONALUSE LDG.OR @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER, REPA IR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 '00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE f V REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS" GATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. L ��-
SIGNED THIS DAY OF I9_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT NEW BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL [I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOSS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA
R OR THAT
I A PERTK-fLE L OWNER OF To ABOVE
DESCRIBED BACKFILL SEPTIC TANKS ❑
SIGNATURE s SEEP.PIT S C] CESSPOOLS
OF PERMITTEE L
®. 7ALT.ATION ROBERT A.WOOD
c. ■.°. O H SUPERVISING MECHANICAL ENGINEER
L`;Co09352 IAY181 0 A 5.00 M