HomeMy Public PortalAbout5425 WELLAND AVE_Sewer__ E'808 3-61
APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAREST
FDDR
OR APPLICANT TO EILL IN CROSS ST,
L
TION LOT N0, OWNER
TRACT MAIL Y �
ADDRESS
NO.OF BLDGS. w�
LOT NOW ON LOT a3 CITY' TEL. NO
GS res DISTRICT NO. GROUP MAP PROCESSED_BY
BI( PG � /
CTOR . '
3 ; CONNECTION DATA
.� a TEL.NO 6,46 DEPTHSTATE MANHOLE REFERENCEATION NO, (� COUNTY l .:
No. i DESCRIPTION OF WORK FEE
J HOUSE SEWER CONNECTING TO
PUBLIC SEWER CI $5.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD Com' $3.00 Y. CURB P.L. M.L.TO P.Lo -
OVERFLOW SEEPAGE PIT,DRAINPIELD ✓r 1'
EXTN..CESSPOOL.DRY WE
52,00 /" (L
HOUSESEWER CONNECTING TO _ f ✓ P.C.NO. O
PRIVATE DISPOSAL SYSTEM $1.00 CO,IMP.NO. _. JOB N0, Cl
CONNECT ADDITIONALBLDG.OR TRUNK PERMIT NO, ROAD PERMIT NO. "
WORK TO HOUSE SEWER $1,00 r' r `�
ALTER,R€PAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM C"� 51.00 PERMIT N0. V
INDUSTRIAL d
WASTE APPROVAL (4
CHARGES z
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
A7��V inOECATION TOTAL FEE - REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEREINCON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS- DAY OIr 19r._._. NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
y�,�
OWNERS AGENT New BUILDING OR WORK
ADORES SEPTIC TANK,SEEP.PIT($)
AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
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 I AM THE LEGAL OWNER OF. THE ABOVE BACKFILL SEPTIC TANKS 0DESCRIBED RESIDER IA' PROPERTY.
SIGNATURE ! SEP.PIT IS CESSPOOLS
OF PERMtTTE ✓>:v"'— ,r rt �' l'
VALMATIOW ROBERT A. WOOD
CK. Y.o, CASH > SUPERVISING MECHANICAL ENGINEER
o "
:E808 67
5AA642D642C) .APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. IENSEN, Supt of Building LOCALITYNEAREST
FADDRESS
OR APPLICANT TO �. IN
CROSS ST.
L OWNER �Y -w-
TION LOT N0. ,
TRACT MAIL
OF
ADDRESS
IVO.OF BLDGS. +� c :? (,-I!y ,
LOT NOW ON LOT J CITY TEL, N0. !r
s DISTRICT NO. GROUP MAP PROCESSED BY
GS BR PG
CTOR • . `7 f $ �' f r
{ ry. -' CONNECTION DATA
TEL.N tON }r'..`l- � ' ` _ DEPTH
STATE MANHOLE REFERENCE
ATION NO. 13909 3 ❑ COUNTY
NO. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM " {
SEPTIC TANK;SEEPAGE PIT OR Y. CURB P,L M,L.70 P,L.
PITS AND/OR DRAINFIELD @ $3,00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL @ $2
.00 - � / >
HOUSE SEWER CONNECTING TO / r ' P.C.N0. O
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP, NO.. / JOB NO, S.1
WORK TOTHbU5FISEWER G.OR @ 57.00 TRUNK PERMIT NO. ROAD PERMIT
ALTER,REPAIR OR ABANDON HOUSEO
.
SEWE OR DISPOSAL.SYSTEM@ $1.00 STATE ENCROACHMENT 76-3
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL N
CHARGES Z
OWNER'S PERMIT $ CONNECTION CHARGE FEE —
AUTHORIZATION TOTAL FES REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE HAVE AT THIS DATE A CONTRACT DESCRIBED EXISTNG DWELLWITH THE HEREIN NAMED ING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER..
SICKED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT �+y� BUILDING ORWORK
NEW 1tlEW 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 ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON!SOUSE SEWER
CALIFORNIA OR THAI'-I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE I .L PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE ./ SEEP,PIT(S). ❑ CESSPOOLS El
ti � "
OF PERMITTE -!_ -;,j
1
VALMATIOX ROBERT A. WOOD
CIL Y.0. { CASH SUPERVISING MEC hkNICAL ENGINEER