HomeMy Public PortalAbout5644 HELEO AVE_Sewer__ D
CE808-a.se APPLICATION FOR PERMIT .
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING 5644 Heleo
]CRN A. LAMHIE. Countyer ADDRESS
CABSATT D. GAIFFIN. Bvp't'1 0!f Building LOCALITY eBlp . e 1 y
FOR APPLICANT TO FILL IN NEAREST way
P3
Z CROSS BT. LL,,„„n
LEGAL
—DESCRIPTION LOT NO. OWNER JohtZeral1
BLOCK TRACT 25202 MAIL
ADDRUs21T21 Mesa ica Road
ADDR US
NO.OF BLDGS. OV i'na
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF Res.
BUILDINGS DISTRICT N0. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR L• D. M. Construction C �.
ADDRESS
5136-No . Bleeker CONNECTION DATA
CRY dwin ParkTEL. N0. ED -30STATION DEPTH
STATE MANHOLE REFERENCE ' 7 PPER ,
REGISTRATION NO. a COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 4$ $5.00 L, v TYPE OF CONNECTIOM LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR Y. CURB / L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $Y.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00HOUSE
PRIVATE SD SEWER NO-
POSAL SYSTEM CONNECTING TO @,$1.00 CO.IMP. NO. JOB N1.
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 a $1,00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS N PF'RMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATIOTOTAL FEE REIMBURSEMENT FEE
I 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.
SIGNED THIS------DAY OF Ig— New HOUSE SEWER /K/ PT/✓i
OWNER OR CONNECT ADDITIONAL /
OWNERS AGENT NL' 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❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I 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 THE A OWNER OF THE ABOVE
DESCRIBED RESIDENTI ROPE �) BACKFILL SEPTIC TANKS[3 -
L�f//C SEEP.PIT(5) ❑ CESSPOOLS ❑
SIGNATURE Yy�
OF PERMITTEE
®. /-- TALIROBERT WOOD
CK. Y..0.o. CASK- SUPERVISING MECHANICAL ENGINEER
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