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Home My Public Portal About5437 WELLAND AVE_Sewer__ E808 10-63 �¢ 8A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOS}SeL -` DEPARTMENT` OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS ,y L - WILLIAM A. JENSEN, Supt of Building a ALITr � NFARE�T -- - FOR APPLICANT TO FILL IN _n ESCRCPTION._ r,'T.-NO _. ) OWNER MAIL HLaC.M Tr,AC;{ ' `� }' AD DRE£iS ( ,gyp J s a OF eLDSS. J SIZE o tar.: 1�#Tl i'. _.._ NOW ON LO'' � - CITY ,/r,/{t�[��- / TE.L. NO. i � USE: LK �pyq ,j DISTRICT NO. GROUP MAP ;Pf<OGE$SED BY i CONTR0. TOA r ADDRESSCONNECTION DATA + �� - CITt'. TEL. NO. STAT 10N D€P":'H -- STATE MANHOLE R.E 1.11ENCF '�, / ! •� REG!STRAT ON NO. COUNTY Na. ! DESCRIPTION OF WORK FEE _ --- rYPE.OF CONNECTION LENGTH FROM !HOUSE Sc,W ER GONMCCTiNG TO Y. CURS P.L. M,L.'TO P,L. ry � .. _. - _ _._ __ PF 5 ANG OR GR,A!NFIF.G OR L $+.0:00 .—_—..— —^_-. P.C.NO �i JHLC SFW ER $9 OO _ ____ _ — / _ co, Imp tyrs `�y OB.NO. (, — _—_._... ROU�5E SEWER CONNE.CTI NG Tn--.—______.___— �___— TR U!YK PE R!.5(T NCS. ROAD PERMIT NO. PRi ATE DISPOSAL SYSTEM @ $3.00 „CN NECT AGJ T10ryA�BLDG. OR — AFFIDAVIT WAIVER E%SEMENT i RECORD, IN5TR Nil' DATE Ems, WORK TO HOUSE SEWER $3..00 ! OVERFLOW SEEPAGE PIT,DRAINFIELD 1{Tf4 'CE SPOOL,DRYWFLL,NRANHOLE @ SS.U.O - . ._ _—__�__—__ HWY, OR ST.WIDENING ze0 RI -�tf.--ri- e'f�Nvfi ABANDON HOUSE 1 EA ROP S.P.i ._.�_�--.f—____v.�. _— E ACHMENT _ .�.— STAT...ENi.RO. / Y1 1,. PERMIT NO.. f ✓e+ INDUSTRIAL WASTE APPROVAL CHARGES ��}+Q,,,�V tR°v� PERMIT 2; 00 -- -- ----------- AV!i3®RI4A 1I®N TOTAL FEE C ONNEC IFJ'N�CHARGE FEE ! HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REi M1RBUR5EMENT FEE �a 7AACTOR TO CONNECT THE ABOVE DESCRIDE6 EXISTING DWELLING - APPRO YALs7 T TO THE PUBLIC" SEWER. f iJATE I INSPECTOR'S tG NAT41 h'E, SIGNED THIS_—�.._._�..,DAY OF ,.__.._._.—_.—.�..19—. — OWNER OR NEW HOUSE SEWER 1 � I _.—_e OWNERS AGENT_,_�..�..T__--- ___�_..Y—.—__��. CONNECT kC>D iT10NAL AD ORES S BIJ!t DING OR WORK S_?T!:;TANK:SEEP,PIT fS., IR ACKNOWI_EO THAT I HAVE READ T'H IS APPL CATION AND/OR.DRAiNFIELD AND STATE THAT THE AB JE .S CORRECT AND AGREE TO COMPLY WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING 1 I PLJMR M r AND SEWER.S. CESSPOOL [I GRYW EiL I HEREBY CERTIFY THAT I AM PROPERLY REG!STEREG AND/OR ALTER,REPAIR,SEWER OR ICENGEDAS RCCQ('IRED BY LOS ANG_ES COUNTY AND STATE OF SEWAGE.DISPOSAL SYSTEM ALIFORN IA OR THAT I AM ?-'HE LEGAL OWNER OF.. ANO 1' END TO DISCONNECT PS.0 AND * SIDE iNd THE ABnV�LSCR'lB- E:St G,E NT'AL Pb+ .. ABANDON HOUSE SEWER SfGnATL RE --� BACKFIL SEPTIC TANK$ E7 _ OF PERMITTEE -...... _ — --___ SEEP,PIT(S) 0 CEsspaei,S Ell VALIDATIQPT ROBERT A. WOOD SUPERVISING MECHANICAL. ENGINEER CK. M.O. CASH E808 5-65 6A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ....E.r E. jOHN A. LVOIIIF. County I ngine,r ... 3/- COLKMAN li. jVNIK11's,sup't. of Huilding LITY LOCALiTY--/4':.� '?p/c NEAREST FOR APPLICANT TO FILL IN CROSS ST. vzt - LEGAL DESCRIPTION OWNER A M BLOCK TRACT/ ADC)LRrss 3 3� NO OF BLDGS- SIZE OF LOT NOW ON LOT CITY ,TEL. NO USEOF -ei DISTRICT NO. GROUP MAP PROLES D BY BUILDINGS D 5K PG CONTRACTOR ADDRESS 5-l'Y'? It L ---CON IqECTIONDATA STATION DEPTH TEL. NO. CITY LICE SFE ICE LYSE UPPER CLASS MANHOLE REFERENCE LOWER -DIE SCRII��fld� O� WORK FEE TYPE OF CONNECTION LENGTH FROM OM HOUSE SEVVER CONNECTING TO CURB P.L. M L TO P.L. PUBLIC BLiC SEWER 5.00 ' I — P,C.NO, �Srp 'F CYANK ITS AND OR DRAiNFIELD 'T $1 0,00 CO. IMP.NO. z JOB NO. 0 C— TRUNK PERMIT N/ ROAD PERMIT NO. &isv-sr-wE�co-�NE TING TO ' u I SPOSAL SYSTEM $ 3.00 4' I R-- DAT CONNECT Abb-I —INSff NO. E WTE R 0 WORK TO HOUSE SE $ 3.00 -3 17" F- u SEWER OR DISPOSAL SYSTEM 3.001 uj HWY. OR Sye WIDENING IL �jXTN.,CF.SSPOOL, MAN.4CLE $ 5.001 t STATE EN ROACHMENT z PER Cp CATION TEST $ rl PERMIT - 'INDUSTRIAL WASTE APPROVAL CHARGES OWNERS -PERMIT 21 00 FEES CONNECTION CHARGE FEE AUTHORIZATION TOTAL I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIJNLBLIRSEMENT FEE TRACTOR TO CONNECT THE: ABOVE DESCRIBED EXISTING DWELLING SIGNATURE SIGNED THIS--DAY OFi9 TO THE PUBLIC SEWER. APPROVALS DATE ---- OWNEROR NEW HOUSE SEWER OWNERS AGENT-------------- CONNECT ADDITIONAL BUILDING OR WORK A D D R E 5 5 CPT'IC TANK,SEEP,PITS) I HERE8Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND. STATE THAT THE E ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR IC-NSED L AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA A 0 THAT I AM THE LEGAL OWNER OF, AND INTEND RESIDE IN, THE ABOVE DESCRIBED DISCONNECT P �IDEP HOU LUG AND g]ALZRTY. ABANDON HOUSE SEWER � ATUR BACKFILL SEPTIC TANKS SEEP,PIT S) ❑ CESSPOOLS PVFRMITTEE.-- ❑, ALIDATION M.0. CASH 04