HomeMy Public PortalAbout5635 HELEO AVE_Sewer__ "AB°aDAPPLICATION FOR PERMIT
cseaa-e.ea COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 5635 Heleo
ADDRESS
JOHN A. GRIFFIN Coun1Y f Built er
CASSATT D. GRIFFIN, $up't of Building LOCALITY emp e i y
FOR APPLICANT TO FILL IN
cROSSS ST. Broadway
AL
DESCRIPTION LOT NO. Z OWNER John R. Fitzgerald
BLOCK TRACT 25202 - MAIL
ADDRESS
21121 mess g! cq Rf),qtj
NO. OF SLOGS. Covina , TEL. N0. ED 2— 2
SIZE OF LOT NOW ON LOT CITY
USE OF TT�
BUILDINGS R DISTRICT N0. GROUP MAP OCESSED BY
• J BK PG
CONTRACTOR . . & M. Construction .JC t
ADDRESS - -No. ee er CONNECTION DATA _
CIT TEL.N0.ED 8-3024 STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. ® COUNTY Gy/
NO. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO .i� -
PUBLIC SEWER @ $3.00 [!
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM Q' S
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L. .2
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXT,
.,,ESSPOOL.DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. NO. �7
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO. J G
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER N $1.00
ALTER, REPAIR OR ABANDON HOUSEt
STATE ENCROACHMENT-
SEWER OR DISPOSAL SYSTEM a $1.00. PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PEST EUU/� CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE (/ v REIMBURS!EIER
FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREICON- APVALS DATE IN9PHCTOR'S SIGNATURE
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTINGLLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF HN EW HOUSER �,�0 •�L 'ri'a�'N
OWNER OR CONNECT IONALOWNERS AGENT p '1� BUILDING ORKSEPTIC TAEEP, PIT(S)ADDRESS AND/OR DIELD1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIATIONAND STATE THAT THE ABOVE IS CORRECT AND AGRMPLY CESSPOOL RYWELL.❑WITH ALL COUNTY ORDINANCES AND STATE LAWATING ALTER,RESEWER ORPLUMBING AND SEWERS. SEWAGE DAL SYSTEMI HEREBY CERTIFY THAT 1 AM PROPERLY REGISND/OR DISCONNEUG ANDLICENSED AS REQUIRED BY LOS ANGELES COUNTY TE OF ABANDON E SEWERCALIFORNIA OR THAT I AM TH EGAL OWNER OABOVE
DESCRIBED RESIDENTI PROP BACKFILL C TANKS❑SEEP. PITCESSPOOLS ❑
SIGNATURE
OF PERMITTE
®e VALIDATION ROBERTA.WOOD
GK. Y.o, CASH SUPERVISING MECHANICAL ENGINEER
0937 ilAY0A 5.00 n