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Home My Public Portal About5428 WELLAND AVE_Sewer__ TELMIPLE IT �ESOS2 B-S9 APPLICATION FOR PERMIT ` COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _ r ADDRESS JOHN A. LAMBIE, Count Engiaeer CASSATT D. GRIFFIN, Supt of Building LOCALITY MMMNEAREST FOR APPLICANT TO FILL IN CROSS ST, LEGAL J,, - DESCRIPTION LOT NO. OWNER BLOCK TRACTMAIL ADDRESS NO.OF BLDG$. r SIZE OF LOT NOW ON LOT -- CITY TEL. NO. USE OF - BUILDINGS _ DISTRICT N0. GROUPC MAP PROCESSED BY _ _ BK PG CONTRACTOR ADDRESS ,-:r . .Y_--�. CONNECTION DATA CITY TEL.NO. NATION y '- DEPTH y L� STATE MANHOLE REFERENCE .,, J - ' UPPER REGISTRATION N0. ❑ COUNTY '� / tC- 'LBl{fEtt N0. DESCRIPTION OF WORK FEE - HOUSE SEWER CONNECTING TO - PUBLICSEWER CIa�$3.00 TYPE OF CONNEC ON LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. ITS AND/OR DRAINFIELD @ $3.00 ✓r_ a yL - OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN-,CESSPOOL.DRYWELL. @ $2.00 HOUSE SEWER CONNECTING TO CO.IMP, N0. +' JOB N O PRIVATE DISPOSAL SYSTEM @ $T,-00 CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER $1.00 TRUNK PERMIT NO. ROAD PERMIT N0. @ ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM C $1.00 PERMIT NO, INDUSTRIAL WASTE APPROVAL CHARGES -OWNER'S PERMIT $ 2 QO 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 DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. - SIGNED THIS DAY Of.-19- NEW HOUSE SEWER _ OWNER OR ,� CONNECT ADDITIONAL A e� OWNERS AGENT BUILDING.OR WORK ADDRESS SEPTIC TANK,.SEEP.PIT(S) AND/OR DRAINFIELD 1 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 PLUMBING AND SEWERS, ALTER,REPAIR, RR SEWAGE DISPOSAL SER OR SEWER O I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR DISCONNECT PLUG AND EM LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONHOUSE NECT D CALIFORNIA OR THAT I AM THE _LEf".1tL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDENTIAL PROPERTY r SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS ❑ OF PERMITTEE i �F VALIDATION ROBERT A. WOOD CK. N.0. CASH SUPERVISING MECHANICAL. ENGINEER L"91 4 5G AU0 21 1 0 D 7.001. ' 'Eso®2E_59 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ., ADDRESS JOHN A. LAMEIE, County Engineer — CASSATT D. (GRIFFIN, Sup't of Building LOCALITY NEAREST m FOR APPLICANT TO FILL IN CROSS ST. LEGAL _ - -- DESCRIPTION LOT NO. _ OWNER. ' BLOCK TRACT MAIL ADDRESS SITE OF LOT NOW ON LOT CITY '- TEL. NO. USE OF BUILDINGS - DISTRICT NO. GROUP BK MAP PG PROCESSED BY — _ JJ CONTRACTOR C _ ,1 ADDRESS *---. -. CONNECTION DATA CITY TEL.NO. - S' 7fON �-} �,} DEPTH c{ ' STATE MANHOLE REFERENCE UPPER REGISTRATION NO, - - ❑ COUNTY NO. [ DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO *' PUBLIC SEWER @ $3.00 TYPE OF ON ECS 0 LENGTH FROM SEPTIC TANK, SEEPAGE PIT OR Y. CU Fx M.L.70 P.L. -' PITS AND/OR DRAINFIELD @ $3,00 v y. , OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL, DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP"C.NO. PRIVATE DISPOSAL SYSTEM @ $I.00 CO.IMP. N0. ^, JOB NO. CONNECT WORK TO HOUSEIONAL SEWcRBLDG.OR r�l .'�'$I.00 TRUNK PERMIT N0. ROAD PERMIT NO. jy ALTER,REPAIR OR ABANN H SE' STATE ENCROACHMENT` SEWER OR DISPOSAL SYS D W M @ $1.00 PERMIT N0. - - INDUSTRIAL WASTE APPROVAL - CHARGES OWNER'S PERMIT $ 2bb--- CONNECTION CHARGE FEE AUTHORIZATION' TOTAL FEE REIMBURSEMENT FEE 1 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 a - OWNER OR - CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS - SEPTIC TANK,.SEEP.PIT(S) AND/ORDRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS .APPLICATION AND STATE THAT THE ABOVE IS CORI2.ECT 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 HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGALC,OWNER,--OF THE ABOVE.< DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE6 SEEP. PIT(S) ❑ CESSPOOLS OF PERAIITTEE.�� - r -,,VALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL. ENGINEER L"914 6t2 "21 1 1 0 25.00- Sl