Loading...
HomeMy Public PortalAbout5353 WELLAND AVE_Sewer__ E808 3-61 APPLICATION FOR PERMIT 6A B42+7D COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FAJOHN A, LAMBIE:CouW;p En insor WILLIAM A. JENSEN. Sup'! of Building FOR APPLIC T TO FILL IN f. =' _= DESCRIPTION LLEGAL OT NO. BLOCK TRACT _ASML �-: ADDRESS N0.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO, GROUP MAP PROISSED BY BK P6 CONTRACTORra,. b ADDRESS �.:�, '?-�e CONNEO`TION DATA CITY r / TEL NO, �` ` C.', STATION d'` f:.� f' DEPTH [" SATE MANHOLE REFERENCE REGISTRATION N0. F [� COUNTY r NO. DESCRIPT[QN OF RIC FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER $$•OO TYPE OF CONNEC}iON LENGTH FROM PTS IANDA�NK,SAEl A EGE PIITOR ca $9.09 Y. CURB P.L. M.L.TOP.L, OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO PC,NO. O PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. - JOB NO. V CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT F SEWER OR DISPOSAL St_fi'TE'F9 @ $1.00 PERMIT N0. U { INDUSTRIAL aw.. A% d WASTE APPROVAL CHARGES �� OWNEWS PERM $ `.._..Z___.QQ.- CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTOR TO HAVE AT CIONNECT THE A OVE DESCRIBED EXISTING€NGWITH THE HEREr� ADWELL NG A'MED CON- PPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OI$ J9s NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK 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 © DRYWEL.L WITH ALL COUNTY ORDINANCES AND STATE. LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY A� STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM THS LEL 0!'F ER 0 THE ABOVE DESCRIBED OR , P ER•TY BACKFILL SEPTIC TANKS [] F SEEP.PIT(S) G CESSPOOLS SIGNATURE OF PERMPTTE °-6"4 - ,(,..:t-�"`-- VALIDATION kOBERT A. WOOD CK. ` M.o. CASH SUPERVISING MECHANICAL ENGINEER Ee08 3.51 APPL.ICAT1 N FOR PERMIT, CA9420 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOH A, CARIBI£, County Engineer ADDRESS WYLL%AM A. J£Ns£N, Supt of Buiidiag LOCALITYMEARES f FORT APPLICANT TO FILL IN CROS ST. 4 F fi,Y LEGAL OWNER m- DESCRIPTION LOT N0. BLOCK TRACT MAIL r ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT ND. GROUP MAP PROCESSED BY . < '- _ __ BK P6 CONTRACTOR ADDRESS f ,. �.� CONIrrTTON DATA CITY F; TEL.NO. q/+, STATION `y !f DEPTH k` F' - STATE MANHOLE REFERENCE UPPER REGISTRATION NO [//iJ a! 1 COUNTY NO. I DESCRIPTION OF,. ORJC HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $5.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. -.CU ry P.L. M.L.TO P.L. ITS AND/OR DRAINFIELD 0 $3.00 ! OVERFLOW SEEPAGE PIT,GRAINFIELD EXTN..CESSPOOL.DRY WELL @ $2.00 n' HOUSE SEWER CONNECTING TO a CO.IMP.N0. r JOB NO. PRIVATE DISPOSAL SYSTEM @ $1,00 CONNECT ADDITIONAL BLDG,OR2 WORK TO HOUSE SEWER SI,O(i TRUNK PERMIT N0. ROAD PERMIT NO < 0 SEWER DISPQ AL SYSTEM HOUSE �p $1.00 STATE ENCROACHMENT t PERMIT NO. W INDUSTRIAL ®.. WASTE APPROVAL cn CHARGES z 0 ,�`S PERMrr $ 2 OO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE try L 3- REIMBURSEMENT FEE I HAVE AT HE HEREIN NAMED CON- TRACTOR TO THIS THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF i9.a.� NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) ANO/0, QRAINFIELD I HEREBY ACKNOWLEDGE THAT I 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 HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY A" STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE3 LEGAL 9"Elt OF ,THE ABOVE DESCRIBED RESIDEN PR F�RTt er;; r BACKFILL SEPTIC TANKS Ll SEEP.P1T(S CESSPOOLS SIGNATURE OF PERMITTE �- '" VA MATION ROBERT A. WOOD =rCK. Y,0. CASH. SUPERVISING MEC14ANICALENGINEER