HomeMy Public PortalAbout5451 WELLAND AVE_Sewer__ -� '. �'
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!6A642U APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER —
BUILDING AND SAFETY DIVISION BUILDING —� q y s
TOI3AT A, IAMBIE. County Engineer ADDRESS F f iyw -
WILLIAM A. JENSEN, Sug't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. .
LEGAL OWNER
DESCRIPTION LOT N0.
BLOCK TRACT t q,+ ry MAIL
DDRESSNO.OF s
SIZE OF LOT NOW ON BLD
CITY r TEL. NO ;�USE OF res,BUILDINGS • DISTRICT NO, GROUP MAP PROCESSED BY
t�p BK PG
CONTRACTOR H B9• ' fl j' ;�>> -
illi i c 1' s yr ,
ADDRESS 2313 E 1.18 STy r y 3 CONNECTION iaPATA �
CITY La TEL.N0.�,o64608 S#11 "0",
�✓ DEPTH
9 n �y STATE MANHOLE REFERENCE -UPPER
REGISTRATION N0,139099_ COUNTY
NO. I DESCRIPTION OF R FEE
HOUSE SEWER CONNECTING TO f
PUBLIC SEWER V $3.00 TYPE OF CONNECTION� LENGTH FROM "
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L, WL.TO P.L. >-
PITS AND/OR DRAINFIELD @ $3.00 -
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,
CESSPOOL.DRYWELL 52.00 � e1
HOUSESEWER CONNECTING TO P.C,NO. O
PRIVATE DISPOSAL SYSTEM @ $4.00 CO,IMP. NO. JOB NO,
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO, ' wWORK TO HOUSE SEWER @ SI.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT' 0
SE: 'F'OR DISPOSAL Si'STEM G�-$4.00 PERMIT N0,
INDUSTRIAL Uj
WASTE APPROVAL d
CHARGES Z
OWNER"S PERM $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ? C,. ` 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 ONEW HOUSE SEWER
OWNER OR T1� CONNECT ADDITIONAL
OWNERS AGENT - - BUILDING OR WORK _
ADDRESS:— SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD i
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION V
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL,_Q _ 1
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 DISCONNECT FLAG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONN HOUSE SEWER
CALIFORNIA OR THAT I A THE LEGAL OWNER OF. THE ABOVE SIGNATURE BACKFILL SEPTIC TANKS
DESCRIBED RESIDENTIAL. P PERTY. SE P,.PIT I5 CANKS 'S
S
. '✓ .1 tea----
OF PERMITiE
VAMATION- ROBERT A. 'WOOD
CK. 9.0. 1r'cuN 1 SUPERVISING MECHANICAL.ENGINEER
A642D61 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �r
JOHN A, LAMBIE, County Engineer ADDRESS N
WILLIAM A. JENSEN. Sug't of Building LOCALITY �--
F01t APPLICANT TO FII1. IN CROSS ST
LEGAL
DESCRIPTION LOT NO. OWNER
A
BLOCK TRACT
p R
Q:.�� ADDRESS 46-,f' J #"? f " ,%y e a✓' v/
110W
OF BLDGS,
SIZE OF LOT Il0W ON LOT CITY �' TEL. NO
USE OF
BUILDINGS reso DISTRICT NO. GROI£P MAP PROCESSED BY
OK PG
CONTRACTORWilliams —
S'
ADDRESS 2351. EL18 St
r: CONNECTION DATA
CITY TEL.NO, lO641)" A ,ON , / 4=- �': DEPTHSTATE
REGISTRATION N0. COUNTY MANHOLE REFERENCE/ ]?r LPPER
s s,wa m
NO. I DESCRIP R FEE
HOUSE SEWER CONNECTING TO _r t €
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM d
PITS AND/OR DRAINFIELDAGE IT OR 33.00
Y, CURB,, P.'L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL W 52.00
HOUSE SEWER CONNECTING TO P.C.NO, 0
PRIVATE DISPOSAL SYSTEM 51.00 CO.IMP,N0, 7,J JOB NO. V
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT No.
WORK TO HOUSE SEWER $1.00
SEWALTER OR OISPO PAIR AL SYSABANTEM HOUSE Cry $1.00 STATE ENCROACHMENT
PERMIT NO. r>
INDUSTRIAL CL
WASTE APPROVAL V)
p�.
CHARGES z
OWNER'S PERT $ 2 00 CONNECTION CHARGE FEE
TTTLORIZATION TOTAL FEE
- REIMBURSEMENT FEE
,A,al�ra
DATE A CONTRACT WITH THE HEREIN NAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS DAY 0 ,- 19._._._ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT y�-�°�y�.ygkl BUILDING.OR WORK
ADDRESS_ _ SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL C] DRYWELL
WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE.DISPOSAL SYSTEtd
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 OR THAT L AM 'THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE IA PROPERTY, j j BACKFILL SEPTIC TANKS [�
SIGNATURE ✓ __SEEP.PIT(S) CESSPO0
OF PERMITTE �� / i�,Lwy�✓¢ 1 ..�' . ;,.` ,j,,.,,
VAIMATI +I ROBERT A. WOOD
CK. M.0e CASH , SUPERVISING MECHANICAL ENGINEER
l t.
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