HomeMy Public PortalAbout5521 WELLAND AVE_Sewer__ 7£BDBs:e,2 7EA642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUiLDi NG
3OHN A. LAMSIE, County Engineer ADDREss�' --
WILLIAM A. JENSEN. Supt of Building
,-
NEAREST
FOR APPLICANT TO PILL IN CROSS ST. ;
DESC Ri PT!(?N LOT NO.. rte.: OWNER •_
- -----'--- -MAIL- ---- - T---
BLQu K TRACT' ..' ADDRESS
NO. OF' BLOGS.
SIZE OF LOT 7 NOW ON LOT CITY ;5'� ,-rrL. NO. -
-__ - ,
usE OF
BUILDINGS DISTRICT NO. GROUP MAP P!iOCUSSE',D By
CONTRACTOR'
ADDRESS r . �,_ ONNECTION DATA
�' .. A719N P i.., - DEPTH
.CITYS
- TEL. NO. 1 irw :'..I•.e �.
STATE MANHOLE.REFERENCE
�UPi Ert
REGISTRATION No.
f.t
_ !� COUNTY 'moi. r''� --,
ION OF
NO HUL�,SE -EWIER�CONNEECTING NOK __-FE$.5.U0 Y _ Cqrp�,A PL M.L,LENGTH ROM --
- --_ 7YP! O CON NE(,YFOhY LE
PV BMC SEWER - .. --- -Y - -- -
i
_ TO F L. -y
-f. -SEEPAGE
.- -_ --- R C.NO
SEFTiCG TANK,S£L PAG£PIT OR j ---
}PITS AND OR DRAINFiELD @ $10,00 I CO_IMP NO. _..L JOB NO.
HOUSES WER CONNE TING TO 'I
ROAD PERM IT NO
TRUNK PERMIT NO
PRIVATE DIS O AL SYSTEM S3.00
ADG7710NALBL G CR AFFIO,aVII WA!V[R
BASktN _ RECORD.1N5_YR NO ,
_DATECUNE Y
WORK TO HOUSE SEWER @ $3 OU /
i
v
_ -{ - — --
I
OVERFLOW SEEPAGE,PIT:L)RAiNFvELC
XTN.,CG_E5.5..P-O.O-L_,GRYW_E..L_.-L,_MAjH_0,....,.-E -_3-_5_._0_0
HWY.( 'S7.WIDENING F.LTE_R: W
-W ER ORD SPOSAL SYS TF:M $3_00 _ STATE ENCROA C li Mc:NT -_-._
jPERMIT NO.
J'--,r` IND USTR Ai
-� `- L- WASTE APPROVAL
CHARGES'
O WNER'� PERMIT �i ,��..n -_ - -- ------- --_-..— --------------AUTHORIZATION ORATION TOTAL FEE � - CONNECTION CHARGE FEE
i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _____ }� ;s. c_- -r._._
TO THE rUBLIC aEWER, APPROVALS ALJ° I DATE 'INSPECTORS 5iGNA'T UR.E
SIGNED THIS _DAY OF_-_19
OWNER OR _ NEW HOUSE SEWER
OWNERS AGENT-
CONNECT ADDITIONAL--_- --_�
BUILDING OR WORK
ADDRESS
_-
_. SEPTIC TANK..SEEP,PIT(S) (
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO ITA fE
AfE !"HAT THE RBAND/OR DRAINFIELD
OVE IS CORRECT A.ND AGREE E TO COMPLY
W{!N SL L. COUNTY fi)RF;v.I N.AN;�ES AND STATE: LAWS REGULATING I
PLUMB NO AND SEWERS. CESSPOOL, DRYWELL
1 HERFt CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR - i^
LICENSE{) AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
Ch1 fFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO -"- ---"_-'--'----'-----"- -'--"-------
D15C:.ONRiECT PLUG AND
Rf'�iDE iN, THE ABOVE Ok"�v:;.R1BED RESIDENT IA.LaRTY. ABANDON HOUSE SEs+t£R
S;GNATURE
of PERMIT"TEE._._. _-_ _ f ", .+�.✓'" BACKFILL SEPTIC 7ANKS rJ ----
...aa�"` SEEP,PIT (5) CJS CESSPOOLS
VALIDATION-- ROBERT A. WOOD
CK, M.O. CASH
SUPERVISING MECHANICAL ENGINEER
' + ,:+.-
APPLICATION FOR PERMIT
;sArazD
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION TNEA
DING _
JOHN A. LAMBIE, County Engineer
ADDRESS � � - --`"-----
WILLIAM A. JENSEN. Sup't of Building v ti
LITY ti•" 1W -..F - v
ET
FOR APPLICANT TO FILL IN
S ST. _
LEGAL
DE5GR1 PTiON LOT NO. .-....= OWNER i a3 p '•.;,.- .-'
MAIL
BLOCK i '� D .ADDRESS
v
NO. OF BLDG5S
SIZE OF LOT / NOW ON LOT CITY - , ^^ TEC... NO
USE OF ---
BUILDINGS DISTRICT NO: GROUP MAP PR OEE.SSEO BY
CONT RAC'TO k't •� -a ".�a' 4..< ' _� -. _ , .,r -
' r
ADDRESS s s -, 4a - CONNECTION DATA
TION �' DEPTH .
CITY TEL NO._..
.:y TATE '.UPp FR _
FERENCE
NO'II Ta AUIESCR[DESCRIPTION OF WORK .-_... FEt.. —_—_� GOU N'TY: -MAN TYPE,OF CON*.ECTlON LENGTH FROM
ter °
I HOUSE SEWER CONNECTING 7,h I - Y. M.L. O}v.L.
PUBLIC SEWER Q
_ _ $_5.00
SE'PiC 7>h!( SEEPAGEPIT OR .. _ -r- - _— _'�. —.
P CO, IMP,NO. 103 NO. yy�
PITS AND OR DRAINFIELD ,4+� Sf0.00 _.—__
(OU
SEWES CONNF TIME i0 TRUNK PERMIT NJ ROAD PERMIT NO.
V ATS O 5P0 AL SYSTEM $3 00 0
___
I
nN NE.%T ADDITIONAL BLDG OR i 4"'FIDAVI7 l %'AIV£R I EASEMENT RECORD.IN TR.NO DAT'E�
NORK TO OIJS•SEWER Q $3.00 J
OVERFLOW SEEPAGE PI..DRAINFiELD1461
EXYN..CES PCOL.,DRYWELL.MYANHOLE f¢a $5.00 (µ�
HWY. U
ALTER.REPAIR OR ABANDON HOUSE OR ST.WIDENING ,ham
I SEWER OR DISPOSAL SYS'T'EM 33,OU
STATE ENCi.OACtiMENT
PERMIT NO
�7[p
7��p WASrE APPROVAL_
OWNER'S PERMIT _ � 2-j oQ(,_ CONNE PIOhI CHARD -P-EE CHARVES-- — __
AUTHORIZATION TOTAL FEE _ _ -
i RAVE'. AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING D`NELLtNG gyp_.
TO THE PUBLIC SEWER. APPROVALS DATE 1.I NSPECTORS SIGNXTURE
SIGNED THIS_..—. CLAY OF___..— ---_-- - - - - -r.-_ ---
i
OWNER OR NEW HOOSE.SEINER
OWNERS AGF"NT_ CONNECT ADDITIONAL 1—
d nNC J.?WORK
.--
._ _. -- -- -- ANWO TANK sEEP. 'IT tai ..I
i�.'t'Y
I IAkRACKNOWLEDGE THAT I HAVE READ THIS AYP[..I..AiION ANL�CSR URAINP ELD
AND SIATE THAT -HE ABOVE IS CORRECT AND AGREE TO COMPLY ---
WITH ALL COUNTY 'OROIN.ANCES AND STATE..LAWS REGULATING
_UM 13
AND SEWERS. CESSPOOL (<"j DRYWELL. []__�_____.
1 HFRE13Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR i�
LIC:l_NSEC> AS REQUIRED BY L03. ANGLES COUNTY AND STATE OF SEWAGE.DISPOSAL SYSTEM
CALIFORNSA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO �---
D S ONNEC T PLUG AND V
RESIDE IN; TH= ABOVE DESCRIBED RESIDENT A. YR OPERTY. ABANDON HOUSE SEWER I
SIG NAFi1RE -- BACKFILL SE•L ANKv 55POOLS-[] -- -
OF ERMTTTEE. - VALIDATION,, ROBERT A. )OOD
I',' SUPERVISING MECHANICAL ENGIN-EER
CK. M.0, CASH,;