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HomeMy Public PortalAbout5555 WELLAND AVE_Sewer__ 'Y6A642Y7 APPLICATION FOR PERMIT 1 $A E-563 92.54 DIVISION OF BUMDING AM SAMY SEWER-SEWAGE DISPOSAL Deparbnent of County Engineer County of Los Angeles BUILDING 1 WM. J. FOX, COUNTY ENGINEERADDRESS _-- CASSATT D.GRIFFIN,SUPT OF BUILDING; LOCALITY FOR APPLICANT TO FILL IN NEAREST - CROSS ST, LEGAL -- DESCRIPTION -_.LOT hi0, _. .---- OWNER BLOCK TRACT MAIL - �----- ADDRESS NOOF DLDGS. - SIZE OF LOT IYO'N ON LOT CITY. ,. - TEL. N0, USE OP .-. .� .._ - _aT. IIIIIIINI BUtLDINCS DISTRICT NO, GROUP MAP IIK PC CONTRACTOR ADDRESS CONNECTION DATA CITY TEL, NG STATION �'" <- DEPTH 9 � t E❑ STATE ;r j MANHOLE REFERENCE REGISTRATION NO. COUNTY _ - �: UPPER hew-E4_ �-- "-` TYPE + CTlON LENGTH FROM ,�� Y No. DESCRIPTION OF WORK FEE CURB P,L. M_L TO_P.L, f HOUSE SE51ER COWN T'(eiG ! PUBLIC SEWER _ Q) $ :?.50 � 3 6,.1 f HOUSE SEWER CONNECTING TO PRIVATE DISPOS_A- SYSTEM 100CONNECT ADDITIONAL ADDITIONAL BLDG. ORCO, IMP. N0. u'' ^-�'' di JOB. NQ. WORK ..TO HOUSE SEWER _ 4 0 __-_ -. --_ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 � J i TRU14K PERMIT N0. ROAD PERMIT NO. ..-- -GISCON'SELT AND ABANDON SEWER - - STA AND/OR DISPOSAL SYSTEM 1.00 PERMIT ENCROACHMENT-_--__-- -----...--._e_ ._�. __-.__..._.. �' PERMIT NO, SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINF'IELD 2 00 I , INDUSTRIAL CE.sSPOGL RYt§£LL.-_ --;. WASTE APPROVAL SPECIAL CONDIT12fS ONLY c 00 j �, CHARGES,. 0 MIS PERMIT �5 -I 1.I 00 CONNECTION cKaRCE PEES — ---- AUTHO��IZATION TOTAL FEE - �- RE11"BURSEMENT FEE I HAVE THIS DATE CO-NTRACTED WITH THE HEREIN NAMED CON. APPROVALS DAT: INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EX.IS i.IN.G DWELLING __.TO THE PUBLIC. SINER - -- NEW HOUSE SEWER SIGNED THIS —_.__._ DAY vi.,. OWNER ON CONNECT ADDITIONAL OWNERS - BUILDING OR WORK F:. :'`+'T..._._._. __ __. _ .._._�_�.__..�.. ._..-_� - - .----..--- - SEPTIC TANK, SEEP, PITS) AND/OR DRAf_NE•IELD _.._.. ..�.„�_.._ I HEREBY ACKNOWLEDGE 'THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ----- W1TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYS'PEm I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF vDISCONNECT PLUG Alia CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SE.WER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS C] SEEP.PIT(!) - CESSPOOL SIGNATURE - OF PERwrTEE - _ WILLIAM J. FOX.COUNTY ENGINEER VA.IMATION BY ST - DEPUTY '' DEPUTY ��- BY BY Y- '' DEPUTY - DEPUTY z (5A6420 APPLICATION FOR PERMIT COURTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ✓ JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building LOCALiTY S FOR APPLICANT TO FILL. O.S T, 0 ESLF GA L T sic _OWNER --- "mPrIoN Lo ­ ­ --- MAIL SLOC'K TRAC r AODRESS 6- 110 0Fll L DG"i. Ap Si,-_F OFLOT NOW ON L.(-)Y' CITY 7. TEL NO BY NO.1 GrOUPI BK MA� PG PROCESSEID CONTRACTOR ----W/- 1��- AEl ADDRESS -T CONNECTION DATA r­& v­.Av-t�l- STATION DEPTH CITY MANHOLE REFERENCE REG ISTRATION NO. D COUNTY CESCR IPT ION OF WORK FEE TYPE Or CONNECTION LENGTH FROM HOUSE SEW ER CONT ECTFNG TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 -r-- P,C-NO. CO,IMP. NO. JOB NO- PITS ANDi OR DRAINFIELD @ $20.00 I�-Yidusp- TRUNK PERMIT NO. ROAD PERMIT NO. PPIVATE DISPOSAL SYSTEM (4) $3,00 E M-EN --i- -W'N NO./ DATE­ AFFIDAV �A!v R EASE CT AOD!TioNAL BT DO.OR HOUSE SEWER $3.00 LJ1 ----------------- HWY.OR ST-WIDENING V'A.L�IER.RE�RA�-R LIR ABANDON O"F SEWER @ $3.00ST-A�E ENCROACH* : M.E N T PERMIT NO, IN DUSTRFAL. WASTE APPROVAL. CHARGES OWNER7S---j-.piRm- .r--r s 21 00 TION CHARGE FEE CONNEC AUTHORIZATION I TOML-FEE I HAVE AT THtS DATE A CONIRACT WITH THE HEREIN NAMED CON REINIP-JRSEMENT FEE TRACTOR TO CONNECT THY. ABOVE DESCRIBED EXISTING DWELALING TO THE PUBLIC: SEVVER, APPROVALS SIGNATURE SIGNED THI S DAY OF­- OWNER OR NEW HOUSE SF',IVER OWNERS GrN CONNECT ADDITIONAL BUILDING OR WORK I. ADDR.ZL',S- T- SEPTIC,TANK,SEEP.PIT(G) I HEREBY ACKATE Tf,'AT NOWLEA CGE HA HAVE READ APPLICA ANWOR DPAINFtfLD AN[) , 5: THF ABOVE IS CIURRECT AND ACRCP TO Co 'I,OLY WITH ALL COUNTY ORDINANCES AND STATE LAW5 REGULATING Pl,ASMBINC. AND .iKW E RS. CESSPOOL 0 DRYWELL ❑ 1 -4 P R 0 PIE,' R PAIR.SEWER OR. . . RE CERTIFY THAT I AM -�LY REGISTERED AND/OR ALTE L!I-NSI-D A',4 REQUIRED BY ', LOS ANGLES COUNT' AND STATE OF SEWAGE DISPOSAL SYSTEM i C AlFCRN�A OR THAT I AM ,THE LEGAL OWNER OF, AND INIElArT DISCONNECT PLUG ANC IN, 'CH AB)",F RESrCENNALP ABANDON HOUSE SEWE TANKS L 4 BACKFILL SEPTIC -ERMITTEE r SEEP,PIT(S) ❑ CESSPOOLS —-VALIDATION ROBERT A. WOOD CK. uTM.O. CASH SUPERVISING MECHANICAL ENGINEER btal S:j 0 9 JX 2 5.0 0", .E80; I0-63 6A6420 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DI POSAL BUILDING AND SAFETY DIVISION BUILDING 7, :- NO, r JOHN A. LANdBIJa, County Engineer ADDREss WILLIAM A. JENSEN, Suy't of Building LOCAL4TYNEARS - - FORtAPPLI T TO FILL IN RD5 G DESCR,PTION L 7T N. / "" OOF MAii_BLOCK (R _T A D S NOW O B D,S,N C c]T CITY USE OE" B UILDINGSk,.4 DISIRICT NO. GROUP A?AP C PROFtSSED BY EK PG CONTRACTOR .S� __ - ____ .._ ._�. ADDR %' CONNECTION DATA ,yam^ STATION DEPTH f 1. Y •.,may S.,K+ _..__.r'� >=- _-G%r" .et. — _._ �y4 41PPE 5T 7E MANHOLE REFERENCE' •y!' <„�,. �.,'r,- �� �. REG 151 RA ON NO �✓ i J '�` ._ .. UUNT'Y rip: jai •+�',:v-Lz L� fi F_SCftI�'TIQt; {'jrr WORK FEE TYPO OF CONNECTIONt_ENGTH FROM _ H'7US SEER N C.ONNEC TING T I Y j LU P.L. M,L TO P.L. PUBLIC SEWER $500 TANK,ALF. TAGE P9T OR ..-_ 1-- P. P G.NO I.. -. CO.Ih9P Pf O. JOB NO j PIT '1ND/OR DRAI NF1 ELD Q2 $1,.0,00 H7 �E S WFa CON'v r-':NG TO PR A-CE D S-05AL SY TEM 53.00 a . TRUNK PERMIT NO. ROAD PERMIT NO. L•:s: CONN r Dal ONA BLD R _ AFF"iDAYF 7 walvice�aas€newt RECORD. 1NSTR.NO.T----DATE - o WORK O HOUSE SEWER � 53.00 ! ala 43 RFLO�f�f_t•PAGE PiT DRA Nri£Lf7 EX r_51POOL.,OR YEL I_MAN H OL F.a 55.00 J"^ HWY,OR ST.WIDENING AC ER REPA R OR ABA^I:JOh HOLSE 5-'W EFr ORD;SPOLA SYSTEM -. _-. _-..- ..---" R: STATE ENCROACHMENT PERMIT NO. INDUSTRIAL. I WASTE APPROVAL ._._s_. _.___. CHARGESOWIV��` PERMIT 2� Oo --.- _.— — -- AUTHORIZATION ; TOTAL FEE "g-X --�r CONNECTIONCHARGE FEE I HAVE AT THfS DATE A CONTRACT WITH THE HERE! NAMED CON- REIM BURS EMENT:FEE TRACT 0P O CO NNE.c, THr-: ABOVE DESCRIBED E ..IND DWELLING __._____ - _.. �..—__—_____.7. TO T i PUBLIC SEWER APPROVALS I DATE INSPECTOR'S G.�C NATURE' SIGNED -rt{!,. OWNER-I NEW HOUSE SEWER j OWNERS.,C_NY.,�_.r CQNNFCT ADDITIONAL E BUILDING OR WORK ADOR5 F_P71C TANK.5E7 p,PiT 15.1 1 HF.-a" kCKNOW1..?;DWE• THAT HAVE READ THIS APPLCA'iION AND/OR©RAINF'IE•L.D AND 5TA7'E'. -.'HAT THE A80VE 15 CORRECT AND AGREE TO COMPLY Vr;`H A C,O Y O?'D'NG NGE.."i AND STATE LAWS RkGULA"(!NG PLUMB-N ANti 'S WFR . _ CESSFOOc. {.j DRYWELL I HEREBY CER'r'9F.. AT I AM PROP" � REGISTE D AND/'OR ALTER,REPAIR,.S cSVcR OR L :EN SED AS R 'I I" BY LOS A GOU"iTY P. D STATE. OF SEWAGE DISPOSAL SYSTEM FO N A - .FIA AA" THE LEG O'' NE F. D INTEND TO ___ _ SCONNEG7 PLUG AND RES.IC ..'. A YE OESCRIB REFI: ..A.i_ OPERTY. ABANDON HOUSF SEWER I OF PER Er L 5ti P7IG TANKS PIT(5) CESSPOOLS 01 VALIDATION" ROBERT A. WOOD CK. M.O. CASH SUPERVIS!NG MECHANICAL ENGINEER I