HomeMy Public PortalAbout5634 HELEO AVE_Sewer__ TEA°A°°
pE808.BS58 APPLICATION FOR PERMIT
7
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING S634 HeleO
MB
JOHN A. LAIE, County Engin.or ADDRESS'
CASSATT D. GRIFFIN, Sup't of Building LOCALITY emp @ 1tyZRodd
'
FOR APPLICANT TO FILL IN NEAREST way
C CROSS ST.
LEGAL
—DESCRIPTION LOT NO. ) OWNER John R. Fitzgerald
BLOCK TRACT 2 202 MAIL ,21121 Idesa Rica
ADDRESS
NO. OF BLDGS. Uovina
ED 2-79257--
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE
BUILDINGS Res• DISTRICT N0. GROUP MAP PROCESSED BY
BK PG
CONTRACTORD. D. & m. Constr Ctio C
ADDRESS 5136 No. Bleeker CONNECTION DATA
CI a win -tark TEL. NO.ED 8-3024 STATION. 'f"�5� DEPTH (1
STATE UPPER
NO.
%_
REGISTRATION N0. ® COUNTY MANHOLE REFERENC �-
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 .L
M.L.
TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL,DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. NO. . 53 q F
PRIVATE DISPOSAL SYSTEM @ $1.00 CO, IMP. NO. JOB NO 7
CONNECT ADDITIONAL BLDG. OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT S - 2 DO CONNECTION CHARGE FEE
AUTHORIZATION FTOTAL FEE 51,10 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE I SPE OR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING N
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT BUILDINGORWORK
SEPTIC TANK,SEEP, PIT(S)
ADORES$ ANO/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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 SEWER$. SEWAGE DISPOSAL SYSTEM .
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANP/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER _
CALIFORNIA OR THAT 1 AM T AL OWNER, OF THE ABOVE
DESCRIBED RESIDENTI ROP TY. BACKFILL SEPTIC TANKS ❑
SEEP. PIT(S) CESSPOOLS ❑
SIGNATURE i
OF PERMITTE
®rLIDATION ROSERTA.WOOD
cK. N.o. CASH SUPERVISING MECHANICAL ENGINEER
LrTo 0 9 2 .7 a twRY 18 1 0 A 5.0 0