HomeMy Public PortalAbout5429 WELLAND AVE_Sewer__ f
'e >aar APPLICATION FOR PERMIT
3 8c t.-C>EB 55-u1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BU1LDINc � � f.
JOHN A. LAMB1E; COUNTY ENGINEER ADDRESS
' CA6SATT D. GRIFFIN, SUNT OF BUILDING LCCALITY !/.,✓j & ,+
APPLICANT TO FILL IN doss ST. ;'; X _ - —
'LEGAL f, - OWNER -. --
DESCRIPTION LOT IVO. •^ _ � ,d`, �" �,.✓ ;`- d �.
-,,TP MAIL
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BLOCIL `-Cl - - y` a� _ .._ hi7URES '" _-_L- y✓ ..- �,,.
N0. OF BLDGS. 6a+)
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CITY,., - TEL. NO.;-
SIZE OF LOT NOW ON LOT
USE-f1 F - �- - - ---- ----`..�--- ,�
BUILDINGS - .t _ _ DISTRICT NO. GROUP I MAP
- ,'_ $ "BK PG 1
CONTRACTOR .C'7L'Ie Constr.
# CONNECTION DATA
L �'w _STATION _d'�!` DEPTH pj:l3.
CITY �C''^L'"'•� TEL. NO. - M,4NHOLEREF'ERENCLUPPER
STATE
REGISTRATION NO �'; — -�_--�
_ -..."3 ��.1.:�.ri------ - —� CJUNTY a-
NO. I- DESCRIPTION OF WORKFEE TYPE OF CTIpN � LENGTH FROM
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- "
1.__� HOUSE SEWER CONNECTING c0 •,
_PUBLICSEWER_ _ _ L � S.HO i ._J I } _ CURB
EPTI
SC TANK,SEEPAGE PIT OR -��_�- -
_ PITS AND/OR ORAINTIELD (al s 3.00 - ---- -- --� -.
04ERFL0>•ti
GENT, DRAINFIELD
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P.'C`N_-=0
_ TN.,CFSSPOOL,DRtWLL,MAh O1.E S 2.O0 IMP. NO. 10SN0:
_:
HOUSE SEWER coNNEc7rNG TO
RIVATE DISPOSAL SYSTEM LOG TRUNK PERMIT NO ROAD PERMIT NO.-
BLDG,
O.-
8L� CONNEC ADDItl0NALSTATE ENCROACH
WORK TO HOUSE SEYVFR c S 1.00 PERMIT N0.
AiTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYa7€J ,C'7
WASTE APPROV L �
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�1
---.-
-
..r€. ✓
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_ --_----- -_. _- CONNECT.ON CHARGE FE
OWNER'S PEn1lT
__ _-_---__-_-- - ). ad___ REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 9 I t APPROVALS
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I HAVE AT THIS DATE A CONTRACT WI'T'H THE HEREIN NAMED CON- APPROY�'LS j _DATE �INSPEC"OR'S SIGNATURE
TRA.CIOR TO LONNI!C-, HE .ABOVE DFS'CRIPED EXISTING DWELLING
TO THF PUBLIC ..c.h2.. NEW HOUSE SEWER
SIGNED THIS DAY OF.--.---. -t9 CONNECT
AbD T70NAL
owl NER , w " BUILDING OR WORK
O
I
WNERS AGE'tt
SEPTI„TANK,SEEP.PITS) - -
AD'DRESS .. _ '� _ b ANUIJR zRAINF7EL.D
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
CESSPOOL.L URS;L'ELL i.
AND ., f,_e. Tx , ISI E: :AROLk. ('n CORRECT AND AGREE TO COMPLY
A'1"(H ALL COUNTY O-DIN..NOES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR I �
FLUtf;.81 P.;> r.,D SEXER5• SEWAGE DISPOSAL SYSTEM
I ?F..-F.,. Y'.
. C RTIVY AT 1 AM PROPERLY REGISTERED PND`GR
DISCONNECT PLUG AND
LICENSED AS HEDU RED BY LOS 1NGEL€5 COUNTY AND STATE OF — '
I ABANDON HOUSE I
0ESFORNIA OR THAT bl T.Ht Lx.CIA.. /J�tYNER OF THE Aa0'tE __. __. .---- -
UESCf+ BED RFS!DFNT!,`,L PAGPERTY. i BACKFILL SEPTI TANKS L� I ,
SIGNATURE '..r } SEEP. PI T]u) !_] CESSPOOL
4y
OF PEiRMITtE'er+'-- .y:....�,.- ✓.�,..r''.'�"m,,.'✓..a,l--
_ - i I
JOHN A, LEAMBIE, COU4TY ENGINEER V ALIDA I $�Fe(7BE}�T A. WOOD, CHIEF FL.BG. INSPECTOR
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