HomeMy Public PortalAbout5551-5553 WELLAND AVE_Sewer__ P2 k7 C-- V
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:E808 A642A213 13fi9
6A 6APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER---SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ✓.v
JOAN A. LAMBIE, County Engineer ADDRESS Wzz —/-
WILLIAM A. JENSEN. Supt of Building LOCALITY !"
NEAREST
FD
OR APPLICANT TO FILL IN CROSS ST. 0 y a
L OWNER �J ..-.
DESCRIPTION LOT N0.
`TRACT MAIL tr l
jo ADDRESS Gad' °� Ian� v
NO.OF BLDGS.
LOT NOW ON LOT CITY' '�-�A'' TEL. N0.
GS res DISTRICT NO. GROUP MAP P OCESSED BY
BK PGcroR • l i� '23 E 8 ;-, CONNEGTI0N DATA
+�gg TEL.NO. S T N DEPTHATION No. .t..J9p COUNTY MANHOLE REFERENCE 7 - t qr PER
NO. I DESCRIPTION OF.WORK FEE
HOUSE SEWER CONNECTING TO _
PUBLIC SEWER $8.00 TYPE OF CONNECTION LENGTH FROM _ y
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $8.00
OVERFLOW SEEPAGE PIT,GRAINFIELD ..
E%TN:,CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO j L P.C.NO. O
PRIVATE DISPOSAL SYSTEM E $1.00 CO.IMP.N0. JOB NO. U
CONNECT ADDITIONAL BLDG.OR ROAD OAD PERMIT NOS
WORK TO HOUSE SEWER $1.00 TRUNK PERMIT N0 (d '
ALTER,REPAIR OR ABANDON HOUSEST ATE ENCROACHMENT 0
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT NO. V
INDUSTRIAL CL
WASTE APPROVAL h
CHARGES Z
O IS PERMIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL ME REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEREINTRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGAMED DWELLING APPROVALS DATE INSPEGTAR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS .DAY OF NEW HOUSE SEWER
OWNER OR new CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESi, SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIEI.D
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
.PLUMBING AND SEWERS. SEWAGE DISPOSAL SYST£
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 1 AM THE LEGAL OWNER OF THE ABOVE BACKFILL PTIC TANKS
DESCRIBED RESIDENTIAL7PROPERTY.
SIGNATURE I / SEEP.PIT(SES) S
C1 CESSA00
OF PERMIT
TE s i-r
tiz ,r
VALIDATION-- . ROBI=R A. WOOD
CII. &.0. ( CAsR f SUPERVISING MECHANICAL ENGINEER
.1
> . A7 e 7/
:, 80APPLICATION FOR PERMIT
5A 642D2D
.JUN-TY OF LOO ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
j
IOHN A, LAM33IE, Cauaty Eng�neer.
WILLIAM A. lENSEN. Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cRoss sr. "
LEGAL OWNER
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT JeL ADDRESS 1,rO +{ _
N0.OF BLDGS. ° CIS A' ty f TEL NO
SIZE OF LOT NOW ON LOT
USE OF
�.es, DISTRICT NO.!GROVP- BK MAP PROCFS3 BY
BUILDINGS PG
CONTRACTOR H, Williams
ADDRESS 2315 e118 S'ts CONNECTION DATA _
J '_ !- DEPTH
y ;
CITY , a TEL.NO. � S A ON - �� --
® STATE MANHOLE REFERENCE I `' ij yUPPER/
REGISTRATION N_O. COUNTY
NO. DESCRIPTION OF� R FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB.' P.L. M.L.TO P.L. J
PITS AND/OR DRAINFIELD @ 33.00 >_
OVERFLOW SEEPAGE PIT,DRAINFIELD G. 0'
EXTN„CESSPOOL.DRYWELL @ $2.00 P.C.NO.
HOUSE SEWER CONNECTING TO CO.IMP. N0. ✓ _ - JOB NO.
PRIVATE DISPOSAL SYSTEM @ $1.00
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO O
WORK TO HOUSE SEWER St.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT u
SEWER OR DISPOSAL S'YSTE @ $1.00 PERMIT N0. w
INDUSTRIAL 0.
to
WASTE APPROVAL
CHARGES ?
OWNERrS PERM S 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE t"i! 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 19_ NEW HOUSE SEWER
OWNER OR neW CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(
SD
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT D HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
CESSPOOL ❑ DRYWEiL
WITH ALL 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 OR THATI AM THE LEGAL OWNER OF THE ABOYE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDEN I PROPERTY. 1 J SEEP PIT(S) ❑ CESSPOOLS
.j.�
SIGNATUREOF PERMITTE "''`
VAI.IDATIOI�I ' ROBERT A. WOOD
CIL it.9. CASK SUPERVISING MECHANICAL ENGINEER
I