HomeMy Public PortalAbout5602 WELLAND AVE_Sewer__ 76AE-669 tf-$8 APPLICATION FOR PERMIT
i&E-66
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D 1 SPOSA L
Department of County Engineer
County of Los Angeles BUILDING �g
JOHN A. LAM.- BIE. COUNTY ENGINEER _ADDRESS � �,. aF✓ l=r��GL' d —
CASSATT D. GRIFFIN, SUPT OF BUILDING _LOCALITY
C'EAREST e
_
FOR APPLICANT TO FILL IN CROSS_ST _LEGAL
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DESCRIPTION -" LAT NO. �&° ----------- OWNER . 3
MAIL
BLO_CK _TR.A:C7 .—_.._ -ADDRESS
NO.OF BLDGS: Q a
SIZE OF LOT _ NOW ON LOT CITY TEL. NO.CITY 4�_;
USED P{_5 z DISTRICT NO. { GROUP MAP
BUCLJ 2 s � -- SK PGA
CONTRACTOR
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ADDRESS °' CONNECTION DATA
CITY . TEL.N0. STATION DEPTH
__.�__�_ -�_:_ MANHOLE REFERENCE }� _ f _ __.UPPER
_ 9---STATE _ _ _ iJ'- w *' g ' LOWER
REGISTRATION NO. COUNTY/
2-
DESCRIPTION Or WORK FEE
NO.
s t` r '� —�--
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO _ Y. CURB P,L. M.L. TO P.L.
PU5LiC SEWER @ $3,50 j_ � -- _ ------- P. __ _--.
SFPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAT14FI ELD $'3.06 --. -- ------w__..�_
OVERFLOW SEEPAGEoI DRAiNF'1ELD t----- P. C. NO.
EXTN.,CESS POOL,DRYA .'LL,M'TNHOLE $2,00 _CO, IMP. NO. JOB NO.
HOUSE SEWER CONNCCING TO
PRIVATE DISPOSAL SYSTEM ----- h $-;._C6 I- _ TRUNK PERMIT NO. ROAD PERMIT NO, _
•
CONNECT A OIT10NAL BLDG OR. STATE ENCROACHMENT
,I WORK 10 HOUs£._SGNIER rr S 1.00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE ---_ -'-- INDUSTRIAL
SEWER OR DISPOSAL SY TEN! r b 1.J0 � WASTE APPROVAL
-..:..i ----- -- - -------- --- ------I-.----
CHARGES
--.--_----"- _- ___-. CONNECTION CHARGE. FEE
t
OWNER'S PERMIT � �— —.._ —-- --------------
00
- — -- --- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH TkE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSICNATURE
Tkr.CTOR "Ti) CONNECT THE ABOVE DESCRIBED EXISTING DWELLING --I
TO THE PUBLIC SFVVER. NEW HOUSE SEWER
SIGNED THIS__. DAT` OF.- _ _ ig..---- CONN CT ADDITIONAL � l-
OWNER OR �'`�J _ BUi,LDING OR WORK
dh'NI:RS r:GEN ....__� - -- — SEPTICTANK SEEP,P[7(S) I -.
ADDRESS_-__ AND/OR DRAiNFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE. READ THIS APPLICATION CESSPOOLO DRY`VELLE]
AND STATE THAT THE ABOVE IS CORRECT AND ACRE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR i
P.LUMSiNG AND SEWERS, S£NAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I 4M GPROPERLY REG ST£RED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATETE OF
CALIFORNIA OR THAT I AM ,;fHE LEGAL OW ER OF THE ABOVE ?BANDO d HOUSE SEWER. -
DESCRIBED RESIDENTIAL PR -RTY: ' ,J BACK-FILL SEPTIC TANKSEj
SIGNATURE % SEEP.NT(S?.L. CESSPOOLS
i
OF PERMITTEE- ri` .
JOHN A. LAMBIE. COU TY ENGINEER yALI�3ATION' ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
• K> M.O. CASH -
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