HomeMy Public PortalAbout5556 WELLAND AVE_Sewer__ SaE-663 11.59 63 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
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JOHN A. 1..AMBIE, COUNTY ENGINEER —ADDRESS -� �--�---
1 CASSATT b. GRIFFIN, SUPT of BUIL DINv LOCALITY . r
NEAREST
_ FOR APPLICANT_ TO FILL IN CROSS ST.
LEGAL .^__. -----'-- J J�.oGac.oa ✓
DESCRIPTION LOT NO, '''�. OWNER
MAIL
BLOCK � TRACT '`.,,+° Ld (�
NO. OF BLDGS.
BIZE OF LOT NOW ON LOT CITY._ TEL. N
USE OF -_—_
BU_ILDINCS DISTRICT N0. GROUP MAP_ _
K
BPG
CONTRACTORTI .'" -
ADDRESS r" �. -. X, —.-�— —_ CONNECTION DATA _--
-- -- — _ d r f
CITY ,/fit v TEL_N0. WC -C9 STATtON �_
MANHOLE REFERENCE ;, y PPER
�'-y ❑ STATE
REGISTRATION N0 _ ,r �❑ COUNTY -
NG. DESCRIPTION OF WORK_ )FEE _ _ —_�, -- _-- --
HOUSE SEWER CONNECTING TO TYPE OF q9F#cCFTION LENGTH FROM
PU_SLIC_SEWER@ $ 3.50 �: _>p. CURBa_.;. _ �4 L. TO-P.L. �, f
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DR:AINFIELD rv' $_3.0_0
OVERFLOW SEEPAGE PIT,.DRAINFIELD ` > i'' P C NO,
FXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 NO ,: a0B NO.
. -�
HOUSE SEWER CONNECTING TG �
PRIVATE DISPOSAL SYSTEM fni $1.00 �� TRUNK PERMIT NO. ROAD PERMIT N-:17/
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHME14T
WORK TO HOUSE SEWER -_--- --c+�-$_5.00 ' PERMIT N_0.-_-------_. �--------_ -- --.-- -
ALTER,REPAIR OR ABANDON HOUSE .INDUSTRIAL
SEWER ORDISPOSAL SYSTEM R) $I:00
-_-_-� __--. -- WASTE APPROVAL
- CHARGES
CONNECTIONCHARGE FEE
OWNER'S PERMIT S i 00 -_._--- --
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE J- `-
I HAVE AT THIS DATE A CONTRACT WITH THE. HEREIN NA9ED CON-' APPROVALS I DATE IINSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS__ DAY OF i9CONNECT ADDITIONALv — -�
OWNER ORrB_U1-LDING OR WORK
OWNERS AGENT / q _ -- -- - ------__-�- ---_-
SEPTIC TANK,SCEP,PIT(S)�
AND;OR DRAINFIFL.D
--HEFEBY ACKNOWLEDGE THAT I HAVE READ THIS APPL CATION
CESSPOOL D DRYW'ELL O I{
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W'ITIP ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -ALTER,REPAIR,SEWER OR I
PLUMBING AND SEWERS. _SEVIAG_E DISPOSAL SYSTEM I �
DISCONNECT PLUG AND .�~�- -_ - -----.--
I HEREBY CERTIFY THAT 1 APA PROPERLY REGISTERED APrD%OP. �
LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF ABANDON NOUS SEWER
j
CALIFORNIA U4 THAT I AM THE LEGAL.>rYNER OF. THE ABOVE -- - -- ;-- --�-
DESCRIBED RESIDENT[. PROPERTY ' BACKFfLL S PTiC ,%NKS❑ i --
SIGNATURE SEeF.PIYISIi� SPOOLS❑ ,
- - -_CES---- - - -;_i,_--
OF PERMITT
1
JOHN A. LANIBIE.o6&ITV LENGINEER -VALIDATION ROBERT A.WOOD, CHIEF PLSG. INSPECTOR
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