HomeMy Public PortalAbout5415 WELLAND AVE_Sewer__ DFPARTXKKT of COUNTY ENOD�T>Wk. '' SEWER--SEWAGE• DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT . LIGATION
COUNTY OF LOS ANGELES .
WILLIAM J. FOX, COUNTY ENGINEER BUILDING J y
ADDRESS
�' / FOR APPLICANT TO FILL/IN ++ LOCALITY
BUILDINNEAREST
ADDRESS ��,LJ /� / J CROSS ST. .. / �/�/ `•� /��..
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LOCALITY � jt!f� �! T-(� ' DISTRICT NO.- SERIAL N0. 'PERMIT N0.
. I A 2.S//Z- 5
CROSS ST. RE. EIVED•B. Ready for Inepectien E IISSSU t,,
OWNER a 71�� _Z/ p/✓ T"
ADDRESS USE ZOW OCCUPANCY AP
BK PG
CITY TELNO.
CONTRACTOR
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ADDRESS4001 Lam% S�/J�'/•'°1 r.1T � v�
JOB.110.
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CITY TEL.NO. z TRUNK PERMIT NO.
REGISTRATION NO. f _�)f_ ?j 1 COUNTY• ROAD PERMIT NO.LEGAL
DESCRIPTION LOT NO. PERMIT NOENCROACHMENT
BLOCK TRACT �� %�G INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
�-7��C'3S t) NOW ON LOT CHARGE!Z.
USE OF /3 - - - -
BUILDINGS R .5, CONNECTION CHARGE EE
NO. DESCRIF+TION. OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO _
PUBLIC SEWER. G $ 8.50' , RECEIPT NO. DATE
HOUSE SEWER CONNECTING TO :
PRIVATE DISPOSAL SYSTEM 1.00'
CONNECT ADDITIONAL BLDG.OR i EXCEPTION REORDED
WORK TO.HOUSE SEWER- 1.00
.ALTER OR REPAIR EXISTING N0. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
- AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR �
PITS AND/OR DRAINFIELO 2.00 STATION 7-r?,j DEPTH
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 / sly' MANHOLE REFERENCE
1 UPPER LOWER.
TYPECTION LENGTH FROM
OWNERS PERMIT # I 00. , c BB -9m. M:L.TO P.L. •�5--
AUTHORIZATION I TOTAL FEE -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT"THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_ DAY OR_� _Iq NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN. C/Ci.[[L x.'1.11. s t ILDIN4 OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS____..:�_7_I._!1_ 'J_�_. 1.. i. !_._ (&_-r+ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI-
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1-AM PROPERLY REGISTERED -DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY'LOS ANGELES COUNTY ABANDON HO PLUG AND
AND
MULTI OF'CALIFORNIA OR THAT I AM THE LEGAL ON ;
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS
�
SEEP.PIT(S)t] CESSPOOLS
OF PERMITTEE..�rW_ __.!'6 "..rL.C ._. }''
78AB42A 669 7/53
MI Vlbtom or BUILDING AND SAFETY ��'������ t D i SPOSAL
Department of County Engineer nmli
County of Los Angeles eL1Le >'
WM.J. FOX. COUNTY ENGINEER ¢
CASSATT T.I. GRIFP71N, SUPT OF SUILn!NG
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION —.LOT NO. - ~CN:,w
N0. OF BLDGS. _ )
SIZE OF LOT NOW ON LOT TEL. N0.
USE OF .� Y
BUILDINGS "- -- _ GiSTRICT NO. f GROUP MAP
I BK FG
ADDRESS -��
_ ds° x sv x - COI�II�T£CT30riI DATA
C7Y �.. C TEL. N0. ". / �',- STATION DEPTH
MANHOLE RLFERENCE
REGISTRATION NO.. COUN?' UPPER----_ LOWER
--�---,�- ❑ T _ __
TYPE OF CONNECTION LENGTH FROM
No. j DESCRIPTION OF WORK FEE Y. CurtB f_L �s.r Io PSL.
�� HOUSE SEN EP CON NECTING TO
P _ _ s� I �� � �' � v '� r ,r ✓ may'
UBkICSEWER ( S
HOUSE SEWER CONNECTING TO —
_ PR VAfE D1Jr'LiSAL SYSTEM 1.00
p CONNECT ADP!TIONAL EILDG. OR CO. IMP,NO, ,JOB, NO.
4 WORK TO I S_E EWER _ 1.00 �!
ALT FR OR 6Fa 'i
REPAIR EXISTING EXJSr G� 1 I
SEWER OR DISPOSAL SYSTEM 1.0 I TRUNK PERMIT N0, ROAD PERM;INO.
-- —I D!SCON dECT AND ABANDON SEWER.. STAT' ENCROACHMENT
A"WOR DISPOSAL SYSTEM _]00 I_ _ STATE
N0.
SEPTIC TANK, SEEPAGE PIT OR
_ Plla AND/OR DR;INFI L_D 2 OO INDUSTRIAL
C SSPOOL DRY' LL - - - -
WASTE' APPROVAL
SPECIAL CONDITIONS ONLY 2.00
-- -- — -- i-- CHAPGES
CONNECYION CHARGE FEE
0 � TPEEtM�£IT _ S i� 1 i 00 —- - - -
AUTHORIZATION � -TOTAL EEE 5EnlrNr FEE
I HAVE THIS DATE CONITRACTED W'TH. THE HERRN NAMED CONn ra �a E
"fkti CTCn TO CONNECT THE AI?OVz DESCRIBED FXISiI'iG DWELLING r APPROVAL DA'iE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEVCRNEW HOUSE:SEvVER
-"— - - -------
SiG`VED THIS DAY OF r # s
ON!PcFR CR- - ;� CONNECT ADDITIONAL
O''ll �S A'l ENT. 4• °mi -�1r- - .;�' ol)ILDING OR WORK
'�` i.«•^' — SEPTIC TANK,SEEP, PITS) --.
ADDRESS, AND/OR DI'.AINFIE'_D `i+!
I HEREBY ACKNO-WLEDGE THAT I HAVE READ. THIS APPLICATION CESSPOOL❑ DRYWELLEl
AND STATE THAT THE ABOVE IS CO-RRECT AND AGREE TO COJ'APLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR
PLUMBING AND SEWERS. ALTER,
DISPOSAL SYSTEM
I HkREBY CERTIFY THAT I .AM PROPERLY REGISTERED AND/OR --'—_" _.- -.--- -.
LiCFNSED AS RErUIRED 13Y LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
c LJFORNIA OR THAT. I AM THE LEGAL OArNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT'iAL PR ERTY.
a� BACKFLLt.SEPTIC TANKS❑
-�' SEEP.PITS) ❑ CESSPOOLS 0,,
SIGNATURE "" ..
OF PERMITT
WILLIAM J. FOX. COUbRtY ENGINEER VAT.mATION �..
3Y is tr
By e
DEPUTY "-"? c.-y �y.. ,,, CEP'UTS.
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DEPUTY DEPUTY