HomeMy Public PortalAbout5435 WELLAND AVE_Sewer__ APPLICATION FOR PERMIT
-DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BU TN
JOHN A. LAMBIE,COUNTY ENGINEER A D Y�l R E X_
CASSATT 0. GRIFFIN, SUPT OF BUILDING
LOCALITY
Na-1
NEAREST
FOR APPLICANT TO FILL IN CROSS ST_ Ap
a
LEGAL
DESCRIPTIONLOT NO, OWNER
MAIL
BLOCK 'f-RAGA
ADDRESS
NO. OF 3LOGS, C!T Y 'v`
SIZE_OF LOT NOW ON LOT
TEL NO
1, " Ii,
USE OF
BUILDINGS N
DISTRICT O. GROUP MAP
CONTRACTOR
e Co n s t r.
CONNECTION .DATA
ADDRESS 'W'
t
DEPTH
6
CITY
TEL NO. 6 C T i�_ PPE PPER
MAN'OLE REFERENCE
STATE
REGISTRATION NO. COUNTY
No. DESCCJUPTION OF WORK TEE
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECT;NG TO
'Y. CURB P.L. M.L.TO P.L. ......
j PUBL!CSEWER
SFj I ANXEEPAGE PIT OR
Si
0", s-i_.CO
OVERFLOW SEEPAGE PIT,DRAINYIELDP. C. NO.
iXTl.,CI-SSPO(-)71,DRYWEi.L,,MAN!4.OL'. $2.0c
- �0 I NO._��� 08 NO.
HOUS,ESEXER CONNECTING TO
P R I V_A
TEDISPOSAL SYSTEM C S 1.00 —TRUNK PFRMI____ ROAD PERMIT_Npl-_Af_c�-��_c
CONNECT ADDIII IONAL BLDG,OR
STATE ENCROA MENT 7
-wORK To HOUSE SEWER G i.0c; PERMIT NO,
ALTER,REPAIR ORABANDON HOUSE
INDUSTRIAL
i SCV41-N OR Di�POSAL SYSTrM. I.C) i. WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEF_
OWNER'S PERMIT I I 00
AUTHORIZATION T OTALF_EE_ REI MD UPSEMENT_FEE
I HAVE AT THIS DATE A CONTRACT VVITH THE HERRN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR 70 CONN"C' TE ABOVE DFSCRIE'10 FXTSTING DWELLING,
TG IHE pu.81'ic SEV--,
NEW HOUSE SEWER
SIGNED TH,S-.-----DA 1,CV
CONNECT ADDITIONAL
OWNER OR _�+"Ke (UILDING OR AORK
-Q1 . ,,1,- ", - _ _
OLIN ERS AGFNT __I—
_,_�2
S1 PTIC TANK,SEEP.PIT(S;
AND/OR, D_RAiNF1FLD________
T
EEHEBY AC N)WLEDGE THAI I H2�VE RE�- TH!S APPLI(-Ali,Drq CES S,-0 0 1,[j PR kUI:L!,
AND 'TiTE Tt T V. E IS C R',E C. AND AGREE TO CON1,PLY
D
r_,L COUNTY ORDINANCES AND STATE LAIhS REGULATING ALTER,Ri,PAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
1 11' CERTIFY Tq,',T I AM PROPERLY REGISTER.ED AND/OR DISCONNFCT PLUC AND
L!CENSED AS R",11-!!RED LOS ANGE LES COUNTY AND STATE OF ABANDON HOUSE SEWER
CA!II:OPN1A OR TILT"'T .1 :'MIT TP-E LF'4 C'NNER OF THE A13OVE
DE-
,3CRIBED RESTT)FNT!Af,"F.R0FFR-IY, BACKFILL SEPTIC TANKS[I
SEEr, PIT S) L] CES9POOLS 71
I�;N AT UR —------
OF PERMITT
fOHN A. LAMBIE, COUNTY ENGINEER IDATION ROBERT A. WOOD. CHIEF PL.B-,. !NSPE—CTOR
0. CASH
3 9 4 31—r, ASG 18 1 Ct A 4,51
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70^E542D APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Las Angeles BUILDING
,tOHN A. LAMBIE, COUNTY ENGINEER AD-DRESS —
CASSATT D, GRIFFIN, SUPT of BUILDING LOCALITY
_ FOR' PPLICA1�dT TO. FILL IN NEARESTio ,- ft
— ---- -- '
LEGAL
. .DESCRIPTION LOT NO _.� ----�^-- OWNER
- MAIL
BLOCK -�-- - TRACT
-_.--��.�-e-' ,5.---- --- --,ADDRESS
NO OF MLCGS.
SIZE OF LOT `R- NGON.LOT--__._�-_.__------ Ci'I'Y a_ '�:^' TEL. N
USE OF
-G"- _�. ._:�_:-__ _------ �. DISTRICTO. i GROUP MA
BUILDING__��. e F
PG
CONTRACTOR
,��KI 's'�".r'.� Bryant
--
CONNECTION DATA
ADDRESS
CITY Irk "`- TEL NO. • WHL
x :,,.DEPTH ."r :.REP'ERi CE _ UPPE.R_..
TATE ------------ LUN_E_R._. I
REGISTRATION NO. f r Irl COUNTY j
NO. ! DESCRIPTION OF WORK IEE ---- -------------- -
_.- -_ TYPE OF CONNECTION LENGTH FROM �. ._ 1
HOUSE SLv`iER
CONNECTING TO -- I I y CUR P.L. M.L. TO P.L. � � i
PUBLIC SEINER !1 53,50' ! - ---- --- ---- '_ -- —.-�—�
SEPTIC TANS,SEEPAGE PIT OR
PITS AND/OR DRAFNFIELD -- rt` - -
5 3.00
OYERF'b.OW SEEPAGE P1T,DRAIN. FIELD I P. C. NO. _
XIN.,CESSPOOL,DRYWELL MAN ROLE t .x.2,00'; _CO. IMP,-NO.`---__-_-�_-JOB NO. 1_
------- ---------------- -
HOUSE SEINER CONNECTING TO
P?,VATE DISPOSAL SYSTEM r,. 1.00_�----�`------_ TRUNK PERMIT NO. ,. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHNT -m F
WORK TO HOUSE EWER ..OL ---- PT NU ---- ,.`
AI TER,REPAIR OP ACANDON HOUSE - -. -
EWER O DISPOSAL SYSTEM rf. j 1.G� j RIAL
_ P
-�� -----.__.. ----- -- - - CHARGES ..
I
II CONNECTION CHARGE FEE
OWNER'S [ PERIYIIIIT --- --
REIMPURSEMENT FEE
AUTHORIZATION TOTAL FicE ��!� 0' y.
APPROVALS � DATE hNSPE, 551 r,-.NI,FURE
1 F:AY l7 THIS DATE A CONTRACT WITH Th `HEREIN NAMED CON•
T;4CTI €2 O CJM1NFri THE ,A604L ;.ESCk .F.tiE'VSTING D41ELL,'dG
TO -HE F is n:t,i,. SE, NEW HOUSE SEWER r
SIGNED THIS _ DAY OF _i
CONNECT ADDITIJPIAL
0 1'11 N.R OR a s 1 rf 4 L'UiLDiNf OR',TURK
OWNERS
„i - -- -- - SEPTIC TANK,SI•F . PIT(S)
ADDRESS =s' , AND/OF DRAINF)ELD � 1
IHFY _AC NGHLEDLE IHA. I HAVE READ THIS APPLICATION
CESSPOOL❑ LRYIiIcLt:J .
AND ,.fE THAT -[HE r\80V:. IS CORRECT AND AGREE TO COMPLY .- --._ ____------. -- --- -_--Y�;_
IV ITH ALL, CC'U74..Y ORDINANCES AND STATE LAWS REGULATING ,ALTER,REPAIR,SEWER OR
PL'J a',3ING AND S_1,VFRS. SEWAGE DISPOSAL SYSTEM _
IiERFSY -CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUS AND
LICENSED AS R'\ W.0F.ED BY LOS ANGELES COUNTY ,'IND STATE OF j
CALIFORNIA LSH THAT I 2M ,y LEGA-h OWNER OF THE ABOVE ABANDON HOUSE SEINER
D'rSCR,BED RES JLNtIAvR P RT BACKFILL r-r'1 C TANKS IJ --- -
SIGNATURE St L _ ] i CESSPOOLS
L,. ..'
S f I'
OF PERMITTEE,,A�;=�^�_ �
I
JOHN A.L.AMBIE., 1A5UNTY ENGINEERAL9DATION ROBERT A.WOOD, CHIEF PLSG. INSPECTOR.
6K. M.0 CASH