HomeMy Public PortalAbout5331 WELLAND AVE_Sewer__ APPLICATION FOR PERMIT"
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL`
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DI'ItISION TLOCALITY
DING
JOHN A. LAMBIE, County Engineer ESS ti �
WILLIAM'A. JENSEN. Eup't of Building
"FOR APPLICANT TO FILL IN s
DES ON OT NO �i OWNER
9 R4 AIL .'
3La "RA r ADDRESS
NO. OF Fi.OGS. " �K
SIZE OF LC>i- NnIA1 ON LCT CITY TEL NO.
U':E GF
80[Loi NGS r !(y, `':;�- DISTRICT NG, GROUP MAP PROCESSED BY
PG
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CON R ._
ATOF?
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ADDRESS CONNECTION DATA
DE PT H
,gyp bad 'jI C, </
!T'Y / TEL NO.
C. 1
wry _ CO-USTATE
NTY /a,.HOLE RE F�'RE NC,F r o ;� i�, � - ��,:.
4.GTR 4TlON NO' �s„J -�-_ L f. COU �JL4W£R+:
N7. DESCRIPTION OF WORK FC _ -.TYPE O>='ON CTq.ON� - �LENGT}{FRC;
HOUSE SFW ER CONNECTING 70 7 Y J' Tf• !!'R'F3 4Y c.. M.L.'PCI P-L.
I t EJL!C:SEWER G --- O
5E TIC -----
TAN 8'.. PA C PIT Dig -�- -- A.C,.NO
ITS.iNOi OR DRAiNFIELD + 610.00 CO:IMP NO. / t ).�- -..,T JOB Ido
LSE WEP CONNFCTINC TO �- _-- r --_ r ._ 7Y
JO
TRUN
PR V" CSPGSAL SYSTEM @ p3.00 PERMIT NO. ROAD PERMIT#t ) il�
_-- -. ____
AF'F(LIAVlT' wkly€'is ease Ma NT RECORD.iNS"R-NO
C NNE,-"ADDITIONAL BLDG.OR - i_- r DATE
_RK-0 HOLISE SEWER.
XTN.,CES.S'POOL,DRYWEL L,MANHO`E, ;a.00 _-r
GO RFLOW SEEPAGE PIT.DRAINFIEL.D $3.00 I I I
L_._--_ HWY, OR ST.WIDENING 4,:
A(TER,REPAIR OR k$ANCON HOI.ISP i I,
bEWER OR >IS?'OSAl..SYSTEM X59.00 i.. _ STATEENCROACHMENT
INDUSTRIAL
r
r 1. i
WASTE A PRE3VaL ! -
_.__ .. CHARGES
C3VWNN `a PERMIT --- ---------–"-------- -----"
AUTHORIZATION TOTAL FEE _� ' � L ONP�LCTION C-TARGE F'EE,
HAVE AT THIS DATE A CONTRACT W;TH THE HEREIN NAMED CON- RE'MBEJ RSEMENT FEE
T RA G TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _._.__
TO THE.RF - o_ti4'F.R. APPROVALS DATE l INSPECTORS SIGNATURE
SIGNED THIS_ DAY OF _ts_ - -------,--------------------
OWNER IR ---^--
NEW HOUSE;SEWER_ -._.-___-
OWNERS A: r`NT�_. - -.—__.- —__ --__--_ CONNECT ADDITION AI_ADDRESS .
BUILDING OR WORK
_._ SEPTIC TANK.SEEP PIT( .)
I Iz ER BY A_NNOWI_EDUC. THAT I HAVE READ THIS APPL I.CATION AND OR Dr2AINFIELD
AND SYATF. THAT THE .ABOVE 15 CORREFT AND AGREE TO COMPLY ._. ..__
"WITH ALL COUN.Y ORDINANCES AND STATE LAWS REGULATING �
PLUMING AND SL:W'ERS_ CESSPOOL a DRY'WELJ- !_]
I H REBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR.PAIR.SEWER OR
L.icr NSED AS REQUIRED BY LOS ANGLES CO:JNTY AND STATE OF ._,..NAGE DISPOSAL SYS-TEM
CA L}FORNI DR THAT I AM ?HE LEAi,- OWNER OF. AND INTEND ?'O DISCONNECT PLUG ,+IND ---�-
RESIDCIN, THE ABOVE DES.LRIBED RESVDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE ,y
✓ + %^��'aF"i"F"'�"` BACKFILL SEPTIC TANKS --- - - -�--�-
OF PERM}TTEE_ f_-_ ^-- - -__ _
SEEP,PIT(S) ❑ _E55POOLS L�
VALIDATION - ROSERT A. WOOD
SUPERVISING MECHANICAL. ENGINEER
CK. M.O. ,rCASH.
CESOS 3-5Z J
7aA��z APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL ul
BUILDING AND SAFETY DIVISION FADDRESS
JOHN A. LAM%BIE, County Engineer I
WILLIAM A... JENSEN, Supt of Building
FOR APPLICANT TO FILL IN CROS ST
— — - — —LD'E,SrRIPI-!ON LOT NO.--._� _ OW_NCR
MAIL. .'.
BLOCK TRA.CT._.-�Y!. _ v _ ADDRESS.
NO. OF' STDG S /,SIZE OF LOT NOW ON LOT' CITY TEL NO.410-4-" "`("
USE
-___ ___ —.. __.- _..._ _— _—__
USE OF y
F3U;LUIN� yTr,,,,'�.. D157F21CT Yi CJ. GROUP .MAP f-'R O4 Et5ED BY
BK PG
,pp
CONTRACTOR
d �
ADDRESS CONNECTION DATA
.yam- _ NO'4 'll� Mf<'+ fTAIF',fON f G..a7N
CITY TEL ...r.—__—
�x� STATE MANHOLE REFERENCE > -, i,+'r
REGISTRATION NO L. C'OUhI7Y -
_7 -.__ - - —_ LOIhER
NO, DESCRiPT iON Or WORK FEE _ 7Vt>B OF�'CO
..-- _ N 'CY:oN LE dKYTi-f FROM
HOUSE SEWER CONN_LT.NG TO �� ,- Y ✓.' 'L7 F�Li _. P.L. M.L.TO Y.L.
1
!
PUBLIC FVe ER $5.D0 P.C.NO
SES C NK Sr PAGE PIT OR i — -- CO. !M7' NO.
_ $1000I JOB:NO
n
_.
FITS AND/OR DRAINIE'LO @ '
_ —_
HOUSE WER.CONNECTING 1'0 -_-_-- - TRUNK PERMIT NO, ROAD PERMIT Py"Qz w
PRIVATE VATE DISPOSAL SYSTEM @ $3.00 0
CONI ECT ADD 7fONAi BLDG.OR AFFIDAVITCRTEAS Ct1CMT RECORD.ItV STR NO: D.AT
WORK TO HOUSE SEWER @ $3.00
_
I
OVERFLOWSEEPAGE PIT.DRAIN f'7€LQ
E XT'd„C SSPOOC,.DRYWELL.MANHOLE@ $5.CiD - -
. ...,._ _-._. t{yyY.OR ST.W IyEN!!NG
ALTER.rtEPA1R,OR ABANDON Hv^U5E
SFWER OR 'PGSAL SYSTEM $3.30
.__—.. _...._-- STATE ENCROACHMENT ,
PERMIT NO.
INDUSTRIAL
} WAST€A PRO)YAL
OVVNEWS HERMIT 00
C' __—
�y H RIZ O CONNECTION CH:A RGE FEE
AUTHORIZATION TOTAL FEE
i
I HAVE AT "I'}{IS. DATE A CONTRACT WITH THE HEREIN�!NAMFO CON- REIM_SURSEM EN_p'FEE
TRACTOR TO CONNECT THE ASO VE DESCRIBED EXISTING DW ELLYNG --------7@ — - - -yg----�a
TO T.{E PUBL C- SEWER. APPROVAL DATE. . ----------- _ D'—A'T} INSPECTORS SIGNATURE
RE
SIGNED THIS__ DAY OFT
OWNER ORNEW HOUSE SEWFR I..
OWNERS AG ENT
' —"—"�---_ - CC>NNE,.TADD!7iONA.L
BUILDING OR WORK
-- - - - -
SEPTIC TAMC,SEEP,PYT(3) .
I HEREBY .ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR DRAIN !ELD
AND STATE. THAT THE. ABOVE IS CORRECT AND AGREE TO ,_OMPLY
WITH ALL COUNTY ORDItNANCZS ANO ST'AT'E LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL. [] DRYW'ELL ❑ �
F
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTER GD ANG,10R AL TER Rc A!R.&EWF_R OR
i..ICEN„rD AS REq:JIRED SY LOS ANGLES COUNTY AND -S,A7E OF
SEWAGE DISPOSAL SYSTEM
C A!..IFOi2"!!A OR TH THAT ! AM THE LEGAL CYVNER OF. ANC 7NTE Ya TO
_.___
DISCONNECT PL'
C UG AND j
RESIDE IN, THE AS IE DE 'CR{k3CO RESI.JCNT[AL PROPERTY. j
0
ABANDON HOUSE SEWER
SIGNATURE
OE 'PER CSA.,,KF L-L SEPTIC TANKS [�I
---'—” - SEEP.-PIT(5) L_I CESSPOOLS
VALIDATION, -- ROBERT" A. WOOD
SUPERV!S!NG MECHANICAL. ENGINEER.
K. M.O. ;ACASH -
APPLICATION FOR PERMIT l
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE, DISPOSAL
Department of County Engineer
County of Los Angeles.I UILD+NG
�fOr-'N A. LANIBIE. CfJY3FdrY � d4IN> �FirDGASSATT°D.G R'IFFIN, SUPT OF BUILDING OCALITY
NEAREST^
FOR APPLICANT TO FILL. IIS Cess sT.
LEGAL
-DESCRIPTIONLor NO. _ OWNER ' :M
---- --
BLOCk TRACT ADDRESS
NO.OF BLDGS, �- GI-490,09
SIZE OF L:OT _ _._. Iia .ltd:4or.: Te
:ITY ejg lC.Q. TEL. NO.
lfa;n•4F DISTRICT NOJ I GROUP _ � MAP
f BK PG
CONTRACTOR M.°alerPlumbing Company
CONNECTION DATA
ADDRESS
___3191_� i Drive
_CITY ,+�, .� J_ TEL. NO. .`75'14 SA'A.TION _ llEPT't:? _
- RFfiR$NCE�
X] STATS ,;.y_ �.;,r' Y� _.4' 'F--_ a _ ,:= L0 ER
RECISTRATtON N.0L*# COUNTY
NO. DESr hIPTION OF WORK - FEE ---- -. ..-- -- - -_--- ___
-- --- TYPE OF CONNaCTiON IENGT�I FROM
NOUS€SEY�ER ONNLCT+NG TO 1 -
Y CURE 1,, P.L. M L'TO P,L,
1 PUBLIC Sk,+cR_ l� $Yv.,'bCa
_ SEPtIC TAMC SEEPAGE PIT OR
PITS AND/OR DRAINFi LD —�-
-i OL k'LQ W SEEPAGE PIT O:R INFIE DIP. C. NO.
c Th
,,DRY1 LI„A ANHO E �c6 $C.00 Ctl. IMP,t+ft).
nSf76 �c + _ -. - ,0f3 NO.
�e
LOUSE SEWER CONN kCTING TO ..-----
f PRIVATE BI.,!'GS.AL S,S CM (rI_ $3.G3 7R(JNX P,;FThi1T NO-,�! �._ ROAD pERM7T N.C:..
--
CONNECT ADDITiCNAL Bi DGOR � STATE €,NCRO,eCHMENT
*-;.- WORK TO HOUSE SL 'ER (' $'1.;7J PERMIT "e C,
ALTER AcP{i12 c?f'�-3hIW D�3is HOUSE _---___-----_...---------
1 - INDUSTRIAL -SEWER 41P BISPOSAA SY -EP WASTE APPROVAL
11AHC L.S
R.
CONN Z CN' FEE:
�a
IL- ERMT A-':! 'DO
REINBURSEMEINT SEE -APPROVALS DATE NPEC"OP SIGN A URE
i HAVE AT DATE A CIONTRACT INITH THE HEREIN NAMED CON- _
TRA.CTOrU CONNECC 7u„ a.,i31t UE,S:RI FD };tlSTIN(, D:4"tELLING. -
n �,jE Pua .i L t -t. NEW HOUSE SEWER
SIGNED TH':S..- — D-AY OF -- 13. —, ---- -` - - - ------
c.oNtiecT Aa:eiT,oNAr.
OWNER Cii '+. ., "UiLD NG OR WOR.ri.
O+iv`PiLRe PGi:NT - — = - SEPT!C TANK,SEEP—ITIS) � -
A[TD5'iE:.S..._._. ANIL 0R DR A.IPd F'E:l:0 �
-- — - -' -- -----�— --- --._._.�1._.'------ ----—
I HEREB`! ACKNOWLEDGE 'THAT 1 HAVE READ THIS APPLICATION DRYWALL,:]
9NA... STATE THAT f}(€- ABt3Y& FS CORRECT AND AGREE TO COMPLY _--------_.--:
lk`:IiH ALL. COUNTY ORDINANCES AND STATE LAWS RF:•'.G:ULATINC. A.TFR, ,.,'.?AIR,SE'NCR OP. I -
LU'AR1 NG AND SF.::R.s. _ � SE'NAGF DISPOSAL SYS IEIA
:'Y T P.. A0[ >:"RM1:PERr_Y Rl_G ISTEft ED AND/ORDSCO\'y_C P-LUG AND
-
NSE' �,S FIQJIRC. BY L.:S PNGELFS COUNTY AND STATE OF At:AN SON nOi1SE.SEWER
CA.?,i .3,i::, CR THPT t AS T _ A-EGAL OVINER OF THE ABUlf.:'E. _-
T1E5.GeRF3RE'SiDENRAL PROP`ERPi. 1. BA;n t. SE.AfitCTr.Nk&
SIGNATURE ? '�;,fi"�> . SE.F. t 7 I LI
o�PERMITT t �• i
1OHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF F'LSG. INSPECTOR
I} k. M.a. GASH