HomeMy Public PortalAbout5338 WELLAND AVE_Sewer__ 76Ae-- -,PPLICiATION FOR PERMIT
CEB�.c!
LCC, ANGELES SEWER-SEWAGE DISPOSAL
01-' tom"jUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING "
]OHN A. LFiMBIE, County Engineer ADDRESS JF H R. r er
CASSATT D. GRIFFIN. Sup t of Building LOCALITY
NEAREST _ $_FOR APPLICANT TO FILL IN CROSS ST
LEGAL e
DESCRIPTION LOT NO. ' OWNER
BLOCK _..,. TRACT i _P �`�`.Y • ;,, MAIL ADDRES -
t
NO.OF BLDGS.. u .,
SIZE OF LOT NOW ON LOT i' CITY y -x'-/, TEL_.N0.
USE OF
BUILDINGS N -' wp _ DISTRICT NO. GROUP MAP
CONTRACTOR; �, r CONNECT,^"' BK PG
ADDRESS / . . /0`�t
> ION DATA
CITY ;� �I,.«',, y �v TEL.NO.,, �'`• ���: "?� =� STATION DEPTH
NO. DE 1 STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. `Yt -� £•.r' 1 _
DESCRIPTION OF WORK FEE T
_ LOWER
HOUSE SEWER CONNECTING TO '�
PUBLIC SEWER @ .$3.50
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AN_D/OR DRA.INFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINF1ELD -
FXTNN_CE,SSPOOL,DRYW£LL.MANHOLE -�k $2.00 -
HOUSE SEWER CONNECTING TO P.C N0,
PRIVATE Df�POSAt SYSTEM ( $1.00 Co.IMP.No. JOB N0.
CONNECT ADDITIONAL BLDG.OR i
WORK.TO HOUSE SEWER 6 $1.00 � "�` � TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE -
SEWER OR DISPOSAL SYSTEM @ $I.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
-�
WASTE APPROVAL
CHARGES
OVMER'S PERMIT s 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL. FEE 4..} REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• i -
TRACTOR TO CONNECT THE? ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE I INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. ` �—
SIGNED THIS DAY.0F NEW HOUSE SEWER
OWNER OR - .: ✓ _ CONNECT ADDITIONAL �— --------._....._---
OWNERS AGENT ,,t� •� BUILDING WORK,
a _
f �` SEPTIC SANK,SEEP,PITS) -'---
AODRESS. ''' �'_ ^_ __AND_fOR_DRA_INFIELD _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL I_[ DRYWEI..L ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - - -
PLUMBING AND SEWERS. ALTER REPAIR,SEWER OR
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR SEWAL,E DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT ) AM THE LEGAL OWNER OF THE ABOVE ARAN_DON HOUSE SEWER
DESCRIBED RESIDkYTIAL PR3t'EyTY BACKFILL.SEPTIC TANKS ❑
SIGNATURE ! SEE.P. PIT(S) []CESSPOOLS0 �
OF PERMITTEE '` � / i i.;y,-�--^ _ "•�s�'`- - "
�g VAL CATION ROBERT A. WOOD
.iC Y r M.Q. CASH SUPERVISING MECHANICAL.ENGINEER