The URL can be used to link to this page

Home My Public Portal About5445 WELLAND AVE_Sewer__ A66 4A6AsT.2[:a_tz APPLICATION FOR PERMIT` •. COUNTY OF LOS ANGELES SEWER—SEWAGE D)SPO AL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADDRESS JM ��_ JOHN A. LPiMEIE, Coun§ly Engineer WILLIAM A. JENSEN, SUp'i of Building LOCALITY ; An NEAREST r FOR APPLICANT TO FILL IN CROSS ST :_L c ESI.RE'I('JN HOT N ,; OWNER 9 f -o MAIL BLOCK TR-ACT d ADDRESS NO OF BS_DGS, SIZE- OF LOT N'OW ON LOT CITY TET_, NO, USE "r 9 ILL NC _ r� s DISTRICT NO. GROY.P; MAP PRO ESSED BY CiINT hA C T rf' 1' ,c �,9"'. iF ' r Y A DRtJI - ON DATA p CONNECTI — -- STATION DEPTH CITY I L_ NO. TATE - RESISTRAT{ON NO J � ® .MANHOLE REFERENCE �UPRER__- ,,,{{{ k COUNTY LOWER NO. Dc SCRIPT! OFWORK FEE TYPE OF CONNECTION LENGTH FROM N OUS *,EWER c_ONNF ING 70 Y, -_CURB .---P.L. M.L. TO P.L. h'UB c SEWER Q �.__ C' NO SEPTIC IAN F.EPAGE PIT OR FTS ANG/OR ORA.INFIELD @ S10.00 ' CO. IME NO. JOB NO. HOUSr,SEWER C^NNEC iINw 70 TRUNK PERMIT NO. ROAD PERMIT NO- F •IVATE 21SPOSAL SYSTEM @ w $3.00 __ _ ____ — _r _ tzN NECI �1'SUI,iONA BLDG—OR 7 -, ,, AFPIDAYtAFFIDAVITn!vra €aerA!*.i I RE�.0 RD 7NSTR NO DP,TE - - ggq,��pppp i Ve ORK TO HOUSE SEWER 0 $3.0 r 4 OY FRFI_OW SEEPAGE PIT,Oft A4NFfELD _L ' EXTN.,CES SPOOL.-DRV WELL,MAN HOLE $5.00 --_-- 4L ER.RF'PAIR OR A13ANDON HOUSE --------� �-�---- _-- �i -�----- 4{'JVY. OR 5T;WIDENING __. E Y'dER OR.�fSPGS AL SYSTEM � 3.00 .STA'T'E ENCWOAL"HMENT Pk .vi tt ttf t�., P-ftM1Y NO All INDUSTFt ALpy y=y t WASTE APPROVAL CHAR ES O R PERMIT 2I, 00 e.� CONNECTION CHARGE FEE AUTFiORIZATIOT3 TOTAL FEE -z:> --- - ---- - ---- -- --`---- --- ---- I HAVE A'r T141S DATEA CONTRACT WITH THE HEREIN NAMED CON- REIMBURM SEENTF_EE TRAITOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ---- -- - ----- �r,J THE PI/.Bl_I.., SF,W`ER. APL�p7 WR® Ai.�a3 DATE`i INSP ECTO R'5 SIGF4A TU RE'. SIGNED THIS --DAY O;z— - ---- --19-- OWNER OR NEW HOUSE SEWER ---ppp--- - OWNERS AC"s7T _.�—_ --- CON'NEC'4 ADDITIONAL - BUILDING OR WORK i ADDRE S I -- '— -- -- - - — -- - -- SEPTIC_TANK SEEP,PIT(S) ' 1 EIER EBY ACKNOVe'1.c^.DGC THAT 1 HAVE READ 7H,5 APPLICATIONAt o/OR DRA-INF:CLD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Ut iTH ALL COUNTY ORDINANCES AND STATE. I_AY REGULATinG ---`Ty F--� PLUMCSING AND SEWERS. 0 CESSPOOL DRYWELL, 1 HEREBY CERTIFY FY THA AM PRO.PERL! REGISTERED AND/OR ALTER,REPAIR,SEWER OR +� 110ENSFDAS REQUIRED BY LOS ANGLES COUNTY AND STATE_ OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT i AM THE LEGAL OWNER OF, AND INTI-.D TO RESIDE IN, THE ABOVE DESCRI.k p ESIDENT1AL PROPERTY. ABANDis DON H PLUG AND ,-` �� A6AN CHOUSE SEWER � SSC-NATO Rs" � 6RE1-."r ISL SEPTIC TANKS OF PERM7TTE - _ ,y ~ .- "' -_ BACK PITTSi. [JTANKCESSPOOLS SEE? __"VALIDATION ROBERT A. WOOD +' SUPERVISING MECHANICAL ENGINEER CK M.O. CASH 4s; I f J' J v. BA&4$D eeoe a-ss APPLICATION FOR PERMIT COUNTY OF LOS ANGELES1 SEWER-SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING i JOHN A. LAMBIE, Counter Engineer ADDRESS CASSATT D. GRIFFIN, Supt of Building LOCALITY ; NEAREST FOR APPLICANT TO FILL IN cRQss ST. _ LEGAL _. a DESCRIPTION LOT NO. - OWNER - BLOCK TRACT MAIL ADDRESS: - NO.OF BLDG$. SIZE OF LOT NOW ON LOTCCTY.� -:•TEL. N0. USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY BK PG CONTRACTOR ADDRESS -. - CONNECTION DATA CITY TEL.NO, STATLON e DEPTH �3 STATE MANHOLE REFERENCE tfPYti.. REGISTRATION NO. Q COUNTY LOWER'' NO DESCRIPTION OF WORK FEE - HOUSE SEWER CONNECTING TO ,- PUBLIC SEWER @ 43AJO, TYPE Q,",CONNE+y:fION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR y, ."`'C1fRa P.L. M.L,TO P.L. _ PITS AND/0R DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT..DRAINFIELD EXTN..CESSPOOL. DRYWEL.L @ $2.00 HOUSE SEWER CONNECTING TOP.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP, N0, . '' " JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT NO WORK TO HOUSE:SEWER @ $1.,00 ✓� ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL 5t'ST'EM C+O $IAO PERMITAQ, INDUT _- WAST ' .f?��I"6� ��::.- tT. ,•f', _ CHARGES OWNER'S PERMITCONNECTION CHARGE FEE Fa FOO- AUTHORIZATION TOTAL FEE - REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN .NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPFCTOR'S SIGNATURE TO THE PUBLIC SEWER. — —r SIGNED THIS DAY OF 1S� NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS. SEPTIC TANK,SEEP.PIT($) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE NS- CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL D WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - ALTER REPAIR SEWER OR PLUMBING AND SEWERS. SEWAGE REPAIR, SEWERDISPOSAL EM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES-CDIt.N,TT AND STATE OF ABANDON HOUSE G AND CALIFORNIA OR THAT I AM THE LEGAL OWNER. OF THE ABOVE DESCRIBED RESIDFN '(AL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT(S) Q CESSPOOLS OF PERMITTED �v VALIDATION ROBERT A. WOOD CK.: H.0. CASH SUPERVISING MECHANICAL ENGINEER `dy 9 6 9 9 SEP 3 1 0 0 7.00- CITY 8A642D APPLICATION FOR PERMIT E808 H•59 COUNTY OF LOS ANGELES SEWER-SEWAGE 'DISPOSA.L DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING TORN A. LAMBIE, Count ADDRESS Engineer —" CASSATT D. GRIFFIN, Supt of Building LOCALITY NEAREST - -. FOR APPLICANT TO FILL IN CROSS ST. LEGAL OWNER , DESCRIPTION LOT NO. d BLOCK TRACT MAIL ADDRESS NO. BLDGS. � SIZE OF LOT NOW ON LOT - CITY TEL. NO. USE OF BUILDINGS _ DISTRICT NO. ROUP MAM774P PROC£SSEWBY BK PG CONTRACTOR ADDRESS a - .:• 'u C_ONNECTION DATA CITY TEL N0, STAtION l DEPTH Q STATE MANHOLE REFERENCE REGISTRATION N0. - '❑ COUNTY kLOWER" NO. DESCRIPTION OF WORK FEE -- -. HOUSE SEWER CONNECTING TO PUBLIC SEWER @..$3." SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM .,.CONN P.L. M.L.TO P.L. r PITS AND/OR DRAINFIELD @ $9.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL,DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO _ P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0,r ROAD PERMIT N0. WORK TO HOUSE SEWER @ $1.00 I SEWEROR DISPOSAL5YSTEM HOUSE @. $1,00 STATE ENCROACHMENT PERMIT:NO. - WAS7ftAPP�A[, CHARGES OWNER'S PERMIT 41 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE (INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF l9� 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 ❑ DRYWELL ❑ WITH ALI. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY .LOS ANGELES.-COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OP. THAT-S AM THE LEGAL OWNER, OF THE ABOVE DESCRIBED RESIDENTAAL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑ OF PERMITTE VALIDATION ROBERT A. WOOD CK. i. U.o. CASH SUPERVISING MECHANICAL ENGINEER L;u l '. a SEP 11 D .2 5.0 '' r