HomeMy Public PortalAbout5639 HELEO AVE_Sewer__ 8
7eAa420 APPLICATION FOR PERMIT.
ceaoa-a.sa COUNTY OF LOS ANGELES1
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Fsginoar ADDRESS O Rel P.()
CASSATT D. GBDFIN, Sup't of Building LOCALITY Temple Cit
CROSS ST. Broadway
NEAREST
FOR APPLICANT TO FILL IN T
DESCRIPTION LOT NO. 16 OWNERVObn-n k• Fitzgerald
BLOCK TRACT 25202 ADDRMAILESS 61121 e$a ZLC�Ta1 ^Oa
SIZE OF LOT NOW ON LOTS CITY Covina TEL.N0. ED 2—/ 72 S
USE OF
BUILDINGS Res, DISTRICT NO.1 GROUP I
BK PG MAP PROCESSED BY
CONTRACTOR . M. Uons:E—Iniction IJ
ADDRESS 5136 No. Bleeker CONNECTION DATA
CITY W1 _ EI)
.n ar. TEL. 10. -.J STATION I DEPTH
STATE
REGISTRATION NO. B COUNTY MANHOLE REFERENCE55—
I PPER t
NO. DESCRIPTION OF WORK FEE `� 1
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $5.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION ,� LENGTH FROM /
PITS AND/OR DRAINFIELD @ $5.00 T. CURB /P.L', j M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN..CESSPOOL.DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER OREPAIR
DISPOSAL SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVVNWS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I 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. NEW HOUSE SEWER
SIGNED THIS OAY OF 19_
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK t
NEW 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❑ DRYINELL❑
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 LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM T LEGAL OWNER 0 THE ABOVE
DESCRIBED RESIDER PR E BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PITS ❑ CESSPOOLS
OF PERMITTE
®. LIDATION _ ROBERTA.WOOD
CK. M.o. WH SUPERVISING MECHANICAL ENGINEER
{ -11.00938fiAY181 0 A 5.00