HomeMy Public PortalAbout5656 HELEO AVE_Sewer__ 70"892O
caeoa-e-aa APPLICATION FOR PERMIT. 1
COUNTY OF LOS ANGELES
nEFAETn�NT of COUNTY ENGINEER SEWER—SEWAGE. DISPOSAL
BUILDING AND SAFETY DWS'
BUILDING HeleoAve. ,
ADDRESS
IOHN A. LAMBIE, Co.ty Engineer
CASSATT D. GRIFFIN, SuP't of Building LOCALITY emp e i "
NEAREST
FOR APPLICANT TO FILL IN
CROSS ST. Broadway
LEGAL
DESCRIPTION LOT NO. 1 OWNER John R.' Fitzgerald
BLOCK TRACT , 25202 _ MAIL 21121` Mesa i�C3 Road
ADDRESS
NO.OF BLDGS. ulna
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO.1 GROUP I
BK PG MAP PROCESSEDBY
CONTRACTOR L. D. & M. Cons
ADDRESS 5136 No. Bleeker CONNECTION DATA -
c1Tr Bal dwin Park TEL. NoED 8-3024 STATION ' DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO. B COUNTY LOWER
NO. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER (d $3.00
' 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.
OVERFLOW SEEPAGE PIT, DRAINFIELD '
EXTN.,CESSPOOL,DRYWELL,MANHOLE 0 $2.00HOUSE SEWER `/
PRIVATE DISPOSAL SYSTEM CONNECTING TO 4D $1.00. CO.IMP.N0. 3 JOB NOO
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 Q $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL "
CHARGES
OWNERS NEWS Y 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS ,DATE �INSPEC�'OR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS-------DAY DAY OF 19_ NEW HOUSE SEWER /�-!
OWNER OR lY w CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK. SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD.
I HEREBY ACKNOWLEDGE THAT 1HAVE 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 1 AM PROPERLY REGISTERED AND/OR ECT PLUG AND
ONN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 'DISCONNECT
HOUSE SEWER
CALIFORNIA OR THAT 1 AM T EG L OWNER OF THE ABOVE
DESCRIBED RESIDENfJ PRO BACKTANKS (:I
SEEP.FPIT(S)ILL EPOC CESSPOOLS
SIGNATURE
OF PER MITTE -
®. / �WAIIDATION ROBERT A.WOOD
SUPERVISING MECHANICAL ENGINEER
!_,iiUD0 9 2 3 5 H0 18 1 0 A 5.0 0 M