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Home My Public Portal About5322 WELLAND AVE_Sewer__ '6'A 11642D =CE808-10-71 APPLI CATI" N FOR RM IT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS LOCALITY LJ NEAREST c FOR APPLICANT TO FILL IN CROSS ST. - LEGAL --- - - JY DESCRIPTION LOT NO - OWNER, MAIL BLOCK TRACT �/ ADDRESS SIZE NO. OF SLOGS, USEOFF LOT NOW ON LOTBKPDISTRICT NO. GROUP MAP 55ED CONTRACTOR - coo ADDRESS �J ! Q" CONNECTION DATA CITY L. NO. ..+ ,r�/� STATION, DEPTH 4L' STATE LIC UPPER ^q MANHOLE REFERENCE LICENSE NO, -_� CLASS . _ ...Lp; 61006- NO. DESCRIPTION OF WORK FEE _ TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER 0 $7.00 SEPTIC TANK.SEEPAP.C.NO. GE PIT OR / PITS AND/_OR DRAINFIELD $1000 CO.IMP. NO. f� 3 J .106 NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O PRIVATE DISPOSAL SYSTEM $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE (J WORK TO HOUSE SEWER @ $3.00 (�(,J OVERFLOW SEEPAGE PIT.DRAINFIELD jw EXTN..CESSPOOL.DRYWELL. @ $5.00 O HWY.OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE � � SEWER OR DISPOSAL SYSTEM $3.00 _ STATE ENCROACHMENT {�j MANHOLE----"-- $7.00 PERMIT NO. (L -- INDUSTRIAL V) WASTE APPROVAL Z OWNERS PERMIT $ 3 00 CHARGES 1 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS _ TO THE PUBLIC SEWER. DATE INSP TO R'S rGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGEN CONNECT ADDITIONAL A BUILDING OR WORK ADDRESS - SEPT IC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEW'E RS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE OVE DESCRIBED RESIDENT[ PROPE Y. ABANDON HOUSE SEWER SIGNATURE ❑ OF PERMTTTE BACKFILL SE {—)� ANKS "- SEEP.PIT( PTC-T S) ,❑ CESSPOOLS ❑ VALIDATION CK, M.D. CASH '6AL642DZC,If808-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS a LOCALITY �ly � 'i FOR APPLICANT TO FILL IN .Ro5555T. LEGAL DESCRIPTION LOT NO. .% / OWNER .-y7 �'—i — MAIL f BLOCK TRACT I�; J ADDRESS I NO. OF BLDG$: ''J' SIZE OF LOT NOW ON LOT r`a---- CITY,% .y �','�'I'!% TEL. NO., USE OF BUILDINGS DISTRICT NO. GROUP MAP 8Y � � SK //PSEONTRACTOR �� . � �- /�2-- 2ESSED q ADDRESS �7 ,�f �. j._'] / ccc..Jll��""' CONNECTION DATA f CITY��/ �'`�. ✓'fv'> TEL. NO. �" __L'�J-jr STATION2— DEPTH STATE �,// LIC /E MANHOLE REFERENCE ICT UPPER LICENSE NO:1��.-/ 7 CLASS G �pyfiil. NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. �� PUBLIC SEWER @ $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD $10.00 CO.IMP.NO. .10B NO: HOU 5 SEWER Cp NNECTI NG TO TRUNK PERMIT NO. ROAD PERMIT NO, PRIVATE DISPOSAL SYSTEM $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER E�SEMENt RECORD.INSTR. NO. DATE V WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD ce E XTN..CESSPOOL.DRYWE LL, @ $5.00 Itti�OR ABANDON HOUSE HWY.OR ST.WIDENING r 1.... SEWER OR^_Cel S*&TFM 53.00 �0 STATE ENCROACHMENT l` Lu $7.00 W rte .- MANHOLE PERMIT NO. 117 d Q - ------ INNDD NUSTRIAL Z WASTE APPROVAL CHARGES OWNER'S PERMIT s 3 00 AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE — IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC S WER. /' DATE INSPECTOR'S SIGNATURE SIGNED THIS DA OF OWNER OR t NEW HOUSE SEWER OWNERS AGENT y,, - CONNECT ADDITIONAL ADDRESS�y,.->2.-fes'-' BUILDING OR WORK -- - —' SEPTIC TANK,SEEP,PIT(5) 1 HEREBY ACKNOWLEDGE THAT I HAVE REA THIS APPLICATION AND/OR.DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY — WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING El AND SEWERS. CESSPOOL ElDRYWELL IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPE TY. ABANDON HOUSE SEWER ✓l� ,I- �,�I�.� SIGNATURE OF PER MffTEE �� ` BACKFILL SEPTIC TANKS ❑ • —c._ :c- SEEP,PITIS) LlQfSSPOOLS VALIDATION CK: ' M.0 CASH y �� 8868$- - APPLICATION FOR PERMIT E808 8•ES COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN. Sug't of Building OCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST, LEGAL DESCRIPTION LOT NO. _OWNER - - BLOCK TRACT 14AIL ADDRESS N0.OF BLDGS. ----- SI7E OF LOT NO4V ON LOT CITY TEL. NO. USE OF -�- BUiLDINGS DISTRICT NO.IGROUP MAP PROCESSED BY BK PG CONTRACTOR ADDRESS - CONNECTION DATA CITY TE .NO. .STATION '`._,t � DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION N0. - O COUNTY +� E• _-'I:LjWER--- NO, DESCRIPTION OF W5-RK--FEE - HOUSE SEWER CONNECTING TO PUBLIC SEWER @0 $9,00 TYPE OF CONNECTION LENGTH FROM X SEPTIC TANK,SEEPAGE PIT OR Y. CURB P,L. M.L.TO P.L. PlI'S AND/OR DRAINFIELD @ 33.00. OVERFLOW SEEPAGE PIT,DRAINFIELD E%TN.,CESSPOOL.DRYWELL. CO) $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. t'' JOB NO. CONNECT ADDITIONAL BLDG..OR. - WORK TO HOUSE SEWER. @ $1.00 d. TRUNK PERMIT N0. ROAD PERMIT NO. !-z• r� ALTER,REPAIR OR ABANDON HOUSE i'TATF ENCROACHMENT SSW""='R ORDISPOSAL.SYSTEM @ $1.00 PERMIT NO. �:NDUSTRIAL WASTE APPROVAL CHARGES OWVNEWS PERMIT S 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED .-EXISTING DWELLING APPROVALS I DATE rNsPECTOR•SSIGNATURE TO THE PUBLIC SEWER, ' SIGNED THIS DAY OF 19— NEW HOUSE SEWER OWNER OR CONNECT A WORK OWNERS AGENT—,—' .------ BUILDING ORR WWORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL CI WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR 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 DISCONNECT CT PLUUSE G AND CALIFORNIA OR THAT I AM THE LEGAL OWNER"'QF THE ABOVE — WER DESCRIBED RESIDENTIAL PROPERTY.. - BACKFILL SEPTIC TANKS Q SIGNATURE - SEEP.PIT(S) 0 CESSPOOLS ❑. OF PERMITTE F f -VALIDATION ROBERT A. WOOD CK. ° Y.0. CBStI SUPERVISING MECkiANICAL ENGINEER, 3� d:,