HomeMy Public PortalAbout5439 WELLAND AVE_Sewer__ Eeaags a APPLICATION FOR`PERMIT 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING " ;
ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICW TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT N0. it OWNER
BLOCK TRACT (p Z'o MAIL
ADDRESS
SIZE OF LOT NOW ON LOTS CITY e -TEL NO.
USE OF
BUILDINGS - DISTRICT NO. GROUP MAP PROCESSED BY
_
BK PG
CONTRACTOR
s
ADDRESS =. CONNECTION DATA If
CITY TEL.NO. STA ON f', /j'. DEPTH
1
STATE MANHOLE REFERENCE ,- .�" :"II+ ER
REGISTRATION NO. COUNTY ? A r -4/ LOWER
NO. DESCRIPTION- OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLICS WER @ $J.00
TYP OF CONNECTb V LENGTH FROM
ITSSEPTIC TANK,SEEPAGELD T OR 00 Y. -�,C( w�T /',{P.L, M.L.TO P.L.
OVERFLOW SEEPAGE PIT', DRAINFIELD I _
I
EXTN..CESSPOOL.ORYWELL @ 2 00
PRIVATE TE DIS OSAL SYSTEM_SE SEWER CONNECTING TO 31.00 CO.IMP. NO. d { I JOB NO.
CONNECT ADD7710NAL 3iDG.OR ^ TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER
C. Sf.00
ALTER,REPAIR OR ABANDONHOUSE 1 STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO.
r
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 OO CONNECTION CHARGE FEE
AUTHORIZATION L TOTAL FEE ::y { REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. i ----
SIGNED THIS DAY OF---Ig— NEW HOUSE SEWER `
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS 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 C) DRYWELL CN
WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE REPAIR,
SE SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE
DISECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFI LL SEPTIC TANKS []
SIGNATURE
SEEP,PIT(S).: •C SSPOOLS 0
/' _
OF PERMITTEE
qr VALIDATION. ~ ROBERT A. WOOD
OS, X.O CAW SUPERVISING MECHANICAL ENGINEAR
,
X808 e.ea APPLICATION"f FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINGtr
ADDRESS
JOHN A. LAMIL Count Eaqineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FELL IN CROSS ST.
LEGAL
DESCRIPTION LOT N0, OWNER
BLOCK TRACT ?> MAIL �u
ADDRESS
P • y':5Z, _. NO.OF BLDGS. i
SIZE OF LOT /p �' NOW ON LOT CITY -TEL. NO.
USE
BUILDINGS DISTRICT NO, GROUP I MAP PRQ.CESSED BY
BK PG J¢
r
CONTRACTOR
-- - m -- ✓i'b 8� <.' � � `Jy ����-ems �l
ADDRESS J CONNECTION DATA
CITY TEL.N0. � *fATION l DEPTH ,
STAT
IOE MANHOLE REFERENCE ' p
REGISTRATN NO. COUNTY �.'p- _'e=- •I� !LOWER
No. DESCRIPTION OF WORK FES
.HOUSE SEWER CONNECTING TO 5`
PUBLIC SEWER @ $3`00
TYPE-OFCONN STI LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR I Y. - ...0 - e L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3100 �-
OVERFLOW SEEPAGE PIT,DRAINFIELD i
EXTN..CESSPOOL. DRYWELL @ $2+00
HOUSE SEWER CONNECTING P.C.NO.
PRIVATE DISPOSAL SYSTEM TO @ $I o 0 CO. IMP. NO. �i ` JOB NO. _
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO,
WORK TO HOUSE SEWER @ $16
ALTER.REPAIR OR ABANDON H.OUSrE STATE ENCROACHMENT
:
EWER OR DISPOSAL SYS .EAI @ $i 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE %..7,."'. 3f" REIMBURSEMENT FEE
TRACTOR TO CIONNECT THE AB VEDATE AT DESCRIBED EXISTINGWITH THE HEREINAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY ONEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT — BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
114EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT Tft.t ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL (] DRY"WELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
E DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE
DISECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL.PROPERTY. BACKFILL SEPTIC TANKS Q
SIGNATURE x' r i f/r „-
SEEP. ) 0 CESSPOOLS
OF PERMITTE
dp VALIDATION ROBERT A. WOOD
CIL X.0. GASM SUPERVISING MECHANICAL. ENGINEER