HomeMy Public PortalAbout5541 WELLAND AVE_Sewer__ 78A5420 APPLICATION FOR PERMIT 1
rDIMION OF SUMDING AND SAFETY EWER--SEWAGE DISPOSAL
Depariment of County Engineer
County of Los Angeles
BUILDING
WM, J. FOX, COUNTY ENGINZrR aDOREss- -- -_-� -- - --
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY
FORAPPLICANTTO FILL IN NEAREST -
cROSs ST,
LEGAL -
DESCRIPTION LOT NO. �. OWNER
BLOCK TRACT MAIL
- -- -- -- ADDRESS - -
NO.OF BLDGS.
IZE OF LOT NOW OAd_LOl' � - CITY TEL. NO,/
USE OF ---._ _
BUILDINGS
DISTRSCT N0. GROUP MAP._.. __ ,�...- BK - PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL. No. STATION DEPTH
C3 STATE MANHOLE REFERENCE
REGISTRATION NO, L.i COUNTY UPPER l'° LOWER
" TYPE OF CONN E TION LENGTH FROM.�"'�
NO. I DESCRIPTION OF WORK FEE 7'. __. . CURB P.L. L.TO P.L..�`
HOUSE SEWER CONNECTING TO
PUBLIC SEWER__ � $ 3_.56
}SOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG. OR -
CO IMP. NO, J(�� NC.
WORK TO HOUSE SEWER -- -- _--
ALTER OR REPAIR EXISTING
SEdER.OR DISPOSAL SYSTEM_ 1.O0 I - iTRUNK PER'Ii17 NO_. '� AD.PERM1T N0.
DISCONNECT AND ABANDON SEWER ! STAVE ENCROACHMENT
AND/OR DISPOSAL SYSTEM_ 1
---� SFs'7 iC CA'YK SEEPAGE P;7 OR —'_' ;-- PERMIT NO. y ---.-_-_—_-
,�,
PITS ANDIOR DRA14FIFLD2 00 3 INDUSTRIAL .+ -
1
CESSPOOL DRYWELL_ WASTE APPROVAL
SPECIAL CONDITIONS 00
ONLY 2-
- ---- � ._ _—I r .�" CHARGES
CONNECTION CHARGEFEE
ovim's PERMIT S 00
AUTHOFIiZATION TOTAL FEE i I FAMBURSEMENT AEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAME CON- APPROVALS D,g7E INSPECTOR°SS'�hATL`k'c
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS-- - DAY O€---- -ri9_— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ,f,_ __BUILDING OR WORK____._-
SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFI£LD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑�DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ ------
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR -
PLUMBING AND SEVERS. _SEWAGE DISPOSAL SYSTEM
IC HEREBY CERTIFY THAT I ARS PROPERLY REGISTERED ANC;`OR DISCONNECT PLUG AND '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE - - - ----
DESCRIBED .RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS-0
SEEP.PIT(S) E} CESSPOOLS[]
SIGNATUPE -
OF PERMITTEE
WILLIAM J. FOX. COUNTY EN6114EFR VA MATION
0 7 2 3' FEB 21 4 4. 0 �
BY BY - -
DEPUTY - ..,. DEPUTY
EY BY
4A DEPUTY DEPUTY