HomeMy Public PortalAbout5606 WELLAND AVE_Sewer__ DEPARTMENT OF COUNTY ENGIIVEER 'f -,SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFEPERMIT APPLICATION
COUNTY OF LOS ANG=ZS` N. n
WILLIAM J. FOX, COUNTY ENGINEER II BUILDING' `�/^ I� /� ' 1 /I y ///J• ,
ADDRESS
•FOR AP ANTTO FILL IN % LOCALITY
BUILDING..!;-/ ff O� EG
NEAREST
ADDRESS w
CROSS ST.
LOCALITY- , DISTRICT N0. SERIAL NO. PERMIT NO. C
NEAREST- A �L� �, J
CROSS ST.•
R EI D B Ready for Inspection DATE ISSUED
o'
OWNER L' e ' l� Ito
MAI
ADDRESS USE OCCUPANCY CM*GBI /PG
CITY TELN0. '/ l��JJ '/ I /�n � t
.17 CONTRACTOR /P.Ll _�y� I
CO.IMP.N0. 3
ADDRESS �,.Z. l. I( `'f 5
JOB.N0.
CITY ~ TEL.NO,/-G C�•C%m TRUNK PERMIT N0. _
ATE
REGISTRATION NO.,_ 1317 U 9% ® COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. uZ STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT ' Q g-cl $ INDUSTRIAL
WASTE APPROVAL.
SIZE OF LOT '1 NOW ON LOTLOG
CHARGES '
USE OF n
BUILDINGS CONNECTION CHARG FEE
NO. DESC IPTION.-OF WORK FEE REIMBURSEMENT FEE
-HUSE SEWER CONNECTING TO
PUOBLIC SEWER Q $ 5.50 15-6 RECEIPT NO. I r TE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 •
CONNECT-ADDITIONAL BLDO:'OR / EXCEPTA RECORDED
WORK TO HOUSE SEWER 1.00 . /. 6 . NO.
ALTER-OR REPAIR EXISTING - TE I BY
SEWER OR DISPOSAL SYSTEM 1.00 I
AND/OR
DISCONNECT
SAL SYSTEM ANDON SEWER 1,00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR o
PITS AND/OR DRAINFIELD 2.00 STATION f DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 6 MANHOLE REFERENCE
mt () 'CHPPER'y LOWER
TYPE OF CONNECTION LENGTH FROM
-Y—. CURB -;°.1= M.L.TO P.L. mC
OWNERS PERMIT ; �. 00 }
AUTHORIZATION' TOTAL FEE _ VrO
L HAVE THIS DATE-CONTRACTED WITH THE .HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING.; APPROVALS- INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED•THIS.__a DAY OF_. aa I0S9, ; 'NEW HOUSE SEWERD-
`• OWNER OR -CONNECT ADDITIONAL
OWNERS AGENT:. �?! 1.:.. BUILDING OR WORK
.�
� �-�Q •yy�� r'� DDpp- r ���j� ? --SEPTIC TANK:-SEEP.PIT(S)
ADDRESS......._. ..d.!:.J!-.§:SCt€"! . .. _.__....._t�r_ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. . 'CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE ,
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS -ALTER.REPAIR.-SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED _DISCONNECT PLUG-AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES' COUNTY. -:ABANDON HOUS
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED.RESIDENTIAL P.11OPERTY.. BACKFILL SEPTIC.T.ANKS
SEEP.PIT(S)[]. CESSPOOLS ci
SIGNATURE _
OF PERMITTEE.Rik.�....:••-... .••......... ............................