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HomeMy Public PortalAbout5419 WELLAND AVE_Sewer__ $ aAe4� - APPLICATION FOR WRMIT �� 1 COUNTY OF LOS ANGELES SEWER-SEWAGE SPOSAL DEPARTMENT OF COUNTY,ENGINEER BUILDING AND SAFETY DIVISION euILDING JOHN A. LAMBIE, Ceuaty Engineer ADDRESS CASSATT D. GRIFFIN, Supt ®fBuilding LOCALITY 4 " NEAREST FOR APPLICANT TO FILL IN CROSS ST. QA LEGAL DESCRIPTION LOT NO. y3 OWNER BLOCK TRACT jY MAIL l ADDRESS NO.OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO, USE OF BUILDINGS DISTRICT NO. ROUP MAP PR4CE D BY BK P6 kv"CONTRAC'T'OR x / ADDRESS t- :• .,-�' :—'"" _ ONNECTION DATA CITY TELNfl.y9 J /J y / ys ILION { p} ">i DEPTH REGISTRATION NO.. L1 STATE/ y f [� COUNTY MANHOLE REFERENCE ,/ >y DESCRIPWN OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER $3.00 d` IYPE OF CONNECTION LENGTH FROM , SEPTIC TANK,SEEPAGE PIT OR CURB P.L. LEN TO P.L. PCIS ANG/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT. DRAINFIELD . EXTN.. CESSPOOL.DRYWELL @ $2.00 HOUSE.SEWER CONNECTING TO - P.C NO. PRIVATE DISPOSAL SYSTEM @ $I,00 CO.IMP NO �' JOB N0. CONNECT ADDITIONAL BLDG.OR '7 WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO ALTER,REPAIR OR ABANDON.HOUSE STATE ENCROACHMENT - SEWEROR DISPOSAL,SYSTEM @ $4.00 PERMIT N0, INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ Q pQ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ID, ATE INSPECTOR'SSIG14ATURE TO THE PUBLIC SEWER. I{{---�-- SIGNED THIS DAY OF g9_ _ NEW HOUSE SEWER OWNER OR ,+Lam,,. CONNECT ADDITIONAL OWNERS AGENT 01 BUILDING OR WORK ADDRESS,. SEPTIC TANK,SEEP.PIT(5) --_ — ANDIOR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE' IS CORRECT AND AGREE TO COMPLY CESSPOOL © DRYWELL 0 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 AHD/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OP. THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED R.ESIDE.�XLI.4 PROPERTY. r BACKFILLSEPTIC TANKS El SIGNATURE , -SEEP. PIT($) [] CESSPOOLS [� OF PERMJTTE �� F VALIDATION. IROBERT'A. wabD u._.. CIS. X.0. tASHSUPERVISING hIECHANICAL ENGINEER a r - 6A642A APPLICATION FOR PE MIT COUNTY OF LOS ANGELES SEWER-SEWAGE D1 OSA:L 1 DEPARTMENT OF COUNTY ENGINEER BUILDING FIND SAFETY DIVISION BUILDING ADDRESS „ ' _ 1."--e JOHN A. LAMBIE, County En neer CASSATT D. GRIFFIN. Supt of Building LOCALITY =` NEAREST '!1�} FOR APPLICANT TO FILL IN CROSS ST. �c ! LEGAL C�9 OWNER DESCRIPTION LOT N0. BLOCK TRACT MAIL ADDRESS NO.OF BLDGS. "� SIZE OF IAT -7/ A NOW ON LOT 13 CITY TEL NO. USE O—FP____g_ BUILDINGS ` �. NO. GROUP MAP PROCESSED BY BK PGCONTRACTOR '. ]DISTRICT a4MG I � A-a P �rAl ADDRESS CONNECTION DATA CITY - TEL.N0, DEPTH — h / ❑ STATE MANHOLE REFERE{dCE J UPPER REGISTRATION NO. � �d ❑ COUNTY I• f I 'y '[ �. 'S' / NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER Era $3..00 PE OF CONNECTION LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR CURB. P.L. M.L.TO P.:L. a s PITS AND/ORDRAINFfELD @_$3.00 EIVERFLOW SEEPAGE PIT,DRAINFIELD ,I -, -t/ •` EXTN_CESSPOOL. DR'YWELL $2.00 "v`. HOUSE SEWER CONNECTING TO f -Y P.C.NO.. - PRIVATE DISPOSAL SYSTEM - @ $1.00 CO.IMP. NO. JOB NO. - CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $7..00 TRUNK PERMIT N0. ROAD PERMIT NO. � ,r ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT - SEWER OR DISPOSAL SYSTEM @ $[< (Y PERMIT NO, -a`_3 _ t .. :':.✓' �{['/� r s L`.t," '_ INDUSTRIAL WASTE APPROVAL ,CHARGES OWNER'S PERMIT I 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 DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS_ DAY OF- 19® _NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT_ I-�"" BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PITS) AND/OR DRAINFIELD ! _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL CI DRYWELL 0 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. SEWAGE EISP08ASYSTEM ALTER,REPAIR,SEWER OR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDE [ - PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PITS) [] CESSPO_ 0 SLS (] OF PERMPTTE � _ rx' .: 3 , - ' 9r CK 'VAMATIO 'H ROBERT A, WOOD SUPERVISING MECHANICAL ENGINEER -. � ., Z.: '••k i.l" del •...,,,1 I s'