HomeMy Public PortalAbout5443 WELLAND AVE_Sewer__ 8A842D
ESOB 8.59 APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER-SEWAGE ®ISPOSW.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
IOHN A. LAMBIE, County Enginoer -
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST T
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
- ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.USE OF _
BUILDINGS � �� - DISTRICT NO. GROUP MAP - - PROCESSED BY
BK PG
CONTRACTOR !„
ADDRESS, a CONNECTION DATA
CITY TEL.NO. STATION ,/ - DEPTH
STATE MANHOLE REFERENCE, UP,Pf
REGISTRATION NO. H COUNTY - LOWER `.
NO. DESCRIPTION OF WORK FEE
,; HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR CURB `: P.L. M.L.TO P.L.
-
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO, % JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNKPERMIT NO. ROAD PERMIT NO -
WORK TO HOUSE SEWER Ca) $1,00 _
ALT ER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM f? $1.00 PERMIT NO.
INDUSTRIAL -
_..,.......__._,.—_.. WASTE APP OPAL r'
CHARGES
OWNERS I PERMIT $ s {( �O CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ( I REIMBURSEMENT FEE
TRACTORATO THIS
THE ABOVE DESCRIBED I
DESCRIBED EXISTTH THE IINGNAMED DWELLING APPROVALS DATE fNSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Cl DRY-WELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALT£R,REPAIR,SE4VER OR
I HEREBY CERTIFY THAT 'I AM PROPERLY REGISTERED AND/ORSEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES-•COUb[TY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT.I AM THE LEGAL OWNFR-.OF THE ABOVE-.
DESCRIBED RESIDENTIAL PROPERTY, - BACKFILL SEPTIC TANKS []
SIGNATURE /` SEEP.PITS) []-CESSPOOLS
OF PERMITTEE
)> "VALIDATION ROBERT A. WOOD
_._,... LCx. X.o. cAslt
SUPERVISING MECHANICAL ENGINEER
I
6 9 8`,� SEP 31. 1 D 2 rJ -
[ F
TEMPLE CITY
8k8420 E808 8•89 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAJ.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.. c
d
SIZE OF LOT NOW ON LOT CITY" TEL, N0.
USE OF
BUILDINGS _ - DISTRICT NO, GROUP - -MAP ,PROCF„SSElD BY
BK PG
CONTRACTOR _ - i
ADDRESS _ CONNECTION DATA
CITY TEL..N0. 'STATION 1 DEPTH_
STATE MANHOLE REFERENCE 3tP6
REGISTRATION N0, COUNTY t LOWER-
NO. DESCRIPTION OF WORK FEE
e HOUSE SEWER CONNECTING TO
PUBLIC SEWER (42..$3.00
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
Y. _!:_, i1RF._ P.L. M.L.TO P.L.
PITS AND/ORbRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN., CESSPOOL.,DRYWELL @ $2.00 —
HOUSE SEWER CONNECTING TO P C.NO,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP, NO. LB NO.
CONNECT OUSE SEWE BLDG.OR TRUNK PERMIT'NO, ROAD PERMIT NO..,
WOP.K TO HOUSE SEWER @ $1.00 _
ALTER,REPAIR OR ABANDON HOUSE S"'ATE ENCROACHMENT
SEWER OR plSPOS L SYSTEM (� $1.60 PERMIT N
INDUSTRIAL
WASTE-APpROVA
CHARGES
OWNER`S PERMIT 5 � 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE � r REIMBURSEMENT FEE
I HAVE AT THIS DA'T'E A CONTRACT WITH THE HEREII-I NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTfNG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF I9_.. NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEUQE 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,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SYSTEM
PLUG SYS
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ,.ABANDON HOUSE SEWER
AND
CALIFORNIA OR THA I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN,' AL PROPERTY. -> BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) 1-1 CES
SPOOL,
E]
OF PERMITTE '' /
9F VALIDATION ROBERT A. WOOD
crr. a,o, c"m SUPERVISING MECHANICAL,ENGINEER
A 13 19 7 vd7 SEP 3 I 7.0 0-
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