HomeMy Public PortalAbout5449 WELLAND AVE_Sewer__ CUI
FCA642v°_�z APPLICATION FOR PERMIT
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COUNTY OF Los ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING {�
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN. Sug't of Building
LOCa.lrr --'-
NEARE T
FOR APPLICANT TO FILL IN CROS5-5T_
DESC P1'ON LOT N OWNER�Y`t Sr j�,.'b.ti.,'wK.•' ads !J ....- ._.
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BLOCK TRACT !► rq, _ ADD.RE S'
NO Cr BI DGS.
514E_0F OT' i�" ON LOIS ..s°" CITY X71 y✓." .�,i � "['L.L. NO. � ~� &�
U E OF �n '-
BGiSTRIC N MAP PROCESSED BY
T O. �aR i1P PROLE 5
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CONTRACTOR ''*.*v ''..:-
,DDDR _S `,n' f r�. a .4s �,. CONNECTION DATA
STATION DEPTH
NO.
STATE MANHOLE REFERENCE, P ---
REG1511ATION NO [] COUNTY j LOW FR
GESCRIP FE
EE OF WORK FE - TYPE OF CONNECTI Ca?J - —- [.ENCTH FROM
HOUSE SEWER CONNEC7ING TO 1 Y CURB P.L WL TO P.L.
Puauc srweR $5 0o I f -- --— -- — -- ---- ---`-- L�
—' — - - - ----- ---- -- --f ---. P C.NO.
Sf PT,C TANK,SEEPAGE PIT C-R JOB NO
I ITS AND/OR.ORA!IJFI El_D Q 10.00 CO.IMP. NO.. _.._ _- __ ._� --_.- ___—__ ---------(' r�°gq,
yCJSE SEWER CONNSCI ING T'O �� TRUNK PERMIT NO. 'yROAD..PERMiT NO. 2,J
PRIVATE DISPOSAL SYSTEM @' $9.00
ON4 C'CRD TIONA BLDG OR i � AFFIDAVLT 6patY€FI ERSEk€N7� CQRD INSTR NJ..- j DATE --
WORK TO HOUSE SEW R @ $3.00 I I j-
_._
V
OVERFLOW SECRAGE Piz DRA N IE>-D i
EXT N CES POOL,DREW EL L,MANHOLE(vs .aa I
-T -. - -_ -- —y- - i-F-vVY-OR S7 WIDENING +4
I A1'e:C-.. -e?L*,T'ATR-'u'R'AAA DON
HOUSE I ._. ..'
j .
gJ'J-p S. n`Dl_%OSAL SSTEM .$3.00
RARJn.. --__ Yv -
/ x.
I PERMIT NO.
INDUSTRIAL ..- ..
I { WASTE APPROVAL
______ _.-__. __._ -___� __.__ C'.HARGE
OVVIVER'S
PER-_ 2 00 ----- - -- --
-- —
_ ____.— ONNEC'T{O CH RGIE 'EE
AUTHORIZATION TOTAL FEE i <;
I HAVE AT TH;S DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED ',ISTING DWELL! t.
N �r�p y__.-_
TO THE PUBLIC SE' E '� # , APPROVALS DATE 1 IM1iSPECTOR S S GNA. RF,
f
SI GN ED THIS - DAY
OWNER OR 't� ,
OWNERS AGENT_ NEW HOUSE SEWER— CONNECT ADDITIONAL - _'r_
ADDRES-4__. BUILDING OR WORK
SEPTIC fA^3.}4 sFEP PI Si
i
HEREBY A 1 N ,W,_E GE THAT I HAVE READ THIS APPLICATION AND/OR DRA,Nr IE L.0
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE' LAWS REGULATING
P L.,iJMBi!vG AND SEWERS CESSPOi)I_ LJ ORYWEt.L
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/QR ALTEIR.RW.PAIR,Sf.Ih ER OF
LI1cFNSED A5 REQUIRED BY LOS. ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
.A.t'F'C>RNiA OR THAT R AM THE LE A1_j WNEfi OF, ANO IN N.D TO DIS,CO' PLUG AN, I- —
tSiDE IN, THE A t4 DE.4CRlBED .REDE TTAl PROPER
ABANDON ONE HO SF F - 1
5JGNATURE
' .� v, BA KF;Lir SEPTIC TANKS J }
OF fERMIYTFE_ SEEP,PIT(SD {._'; CESSPOOLS Ela.
VALIDATI ROBERT A. WOOD
✓ �` ' SI_1A RV1SINCE MECHANICAL. ENGINEER
CK. M.O. CASH'