HomeMy Public PortalAbout5423 WELLAND AVE_Sewer__ 6A6d2C1 6A642 -6,
FAPPLICATION FOR PERMIT
.
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AODBEss -f ``� A
IOHN A, LAMBIE, County F,uggfa®gs
WILLIAM A. IENSEN. Supt of fluilding LOCALITY =---�
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL _ OWNER% aha
DESCRIPTION L47 NO.
BLOCK TRACT MAIL
ADDRESS 4.
SIZE OF LOT NOW ONLOT CITY -,P tf'l IV.4 TEL N0
USE OF
DI DISTRICT NO. GROUPI MAP PROCESSED by
BUILDINGS _ - _ ,sx PG ;
CONTRACTORWilliams l�r
ADDRESS 315 9. 118 S` . ; CONNECTION DATA
CITY TEL.N0. QV Th�f10N '""j' C. DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO. 8 COUNTY tt _ Lam ;=
NO. I DESCRIPTION OF WORK FEE
HOUSE
SEINEN.CONNECTING TO $3.00
TYPE OF CONNECTION LENGTH FROM
PEPICITS AND/OR DRAINFIIELDSEEPAGE PIT
OR @ $3.00 Y. CUR@ ., P,L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT.DRAINFIELD ^� ! J
EXTN.,CESSPOOL,DRYWELL to S2.00 I'
HOUSE SEWER CONNECTING TO > ? P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO,1MP,N0. JOB N0,
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N C�
WORK TO HOUSE SEWER $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT 0
SEWER OR DIS SYSTEM @ $1.00 PERMIT NO. ()
INDUSTRIAL Uj
WASTE APPROVAL I0'
CHARGES Z
OWNER'S FST $ CONNECTION CHARGE FEE
`FEE REIMBURSEMENT FEE
AUTHORIZATION TOTALTOTAL ��,
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- NEW HousE sEWER
OWNER OR new 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 ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY- CERTIFY 714AT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE � '' .� SEEP.P1T(S) CESSPOOLS
OF PERMITTE
% VALMATIOX ROBERT A. WOOD
cK. H.O. CASH SUPERVISING MECHANICAL ENGIN"A
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Y
-E808 ;X
76A642ofi4 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER--"SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION[ BUILDING - -'
JOHN A, LAMBIE, County Engineor ADDRESS ' + �1►d%5
WILLIAM A. IENSEN. Sup'f of Building LOCALITY _ e� -
NEAREST
FOR APPLICANT TO FILL IN cRDss ST.
LEGAL, .
DESCRIPTION LOT NO. OWNER c -
BLOCK TRACT MAIL I
ADDRESS 4
Le`
NO.OF BLDG$.
SIZE OF LOT NOW ON LOT CITY & TEL. NO e C
USE OF
BUILDINGS DISTRICT N0. DROIT MAP PROCESSJED BY
Williams , �K PG
i9PJ
CONTRACTOR H. ams J,. �f � � �"} Z�
ADDRESS 2315 E. 118. CONNECTION DATA
CITY �sr+i TEL.NO. lo6460a SfiATIOx E f DEPTH
STATE MANHOLE REFERENCE / j UPP
REGISTRATION N0. COUNTY �.
N0. DESCRIPTION OF YV RK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3,00 TYPE OF CONNECTIONLL LEIVGiti FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CU P.L. M.L.TO P.L.
PITS AND/OR DPAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD _ -
EXTN..CESSPOOL.DRYWELL « $2.00 iL
PRVEP ! ETD
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.INP.NO. OB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. _r 09
WORK TO HOUSE SEWER _ @ $1.00
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT 0
SEWER OR DISPOSAL SYSTEM ( $1.00 PERMIT N0. (,
INDUSTRIAL LU
WASTE APPROVAL 0"
In
CHARGES Z
OWNER'S PERMIT � 2 00 CONNECTION CHARGE FEE
AtJTFIORIZATION TOTAL FEE $ REIMBURSEMENT FEE
I HAVE AT T1I1S DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAIS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS--DAY OP- lS NEW HOUSE SEWER
OWNER OR ne-W CONNECT ADDITIONAL
OWNERS AGENT 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 13CORRECTAND AGREE TO COMPLY CESSPOOL [I DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING.AND SEWERS. SEWAGE DISPOSAL SYSTE
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1.AM THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS
DESCRIBED RESIDEN JALJPROPERTY. y
SIGNATURE /�.., �% y SEEP.PET(S) 11 CESSPOOLS
OF PERMITTE r - + 1:. ✓i:.. .
�.
VMMATIOPI---- ROBER'T'A. WOOD
CK. M.0. :?` CASH''` SUPERVISING MECHANICAL ENGINEER
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