HomeMy Public PortalAbout5613 WELLAND AVE_Sewer__ 7BA66
E- APPLICATION /FOR PERMIT
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, DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE,COUNTY ENGINEER
ADDRESS
CASSATT D. GRIFFIN: SuF•r OF BU5LOING
NEAREST —
F4R APPLICANT TO FILL IN CROSS sT. , Z-
LEGAL
DESCRIPTION LOT NO. �_�' - OWNER
BLOCK TRACTf MAIL
-.-- _�_✓e' _ -ADDRESS-� _i w �""""'�- � -'
NO, OF BLDGS. CITY FEL. NO.
SIZE QF LOT _ NOW ON LOT
USE OF
BUILDING' F,.;1 ,:�^� DISTRICT-NO. GROUP MAP
EK PG
CONTRACTOR
— 6 _CONNECTION DATA
ADDRESS -
F - STATION DEPTH _
-CITY ,. " , TEL NO. ,.. -- ----..— -,------ --- --- -
---- '� ' MANHOLE REFERENCE - -,--_UPPER
❑ STATELOWER
M73
ARATION NO. ❑ COUNTY ------�9 'e ��
NO, j DESCRIPTION Of WORK FEE _�'
—1fkIO-USE_SEWER----CONNECT'1P1
---GTQ--- -- ----- TYPE OF CONNECTION LENGTH FROM
j Y. P.L.
PUBLIC SEWER $33.50! - -- CURB-----------�M.L.TO P.L.
--- ----.-
SEPTIC TANK SEEPAGE PIT OR I
PITS AND/OR DRAINFIELD (a-, $3.00 __.-...e.—_._PC.
-_.__..�...-____- __..-.
---j .ER_._- _ ,D ------ ----- P C N0.
OVFLO. Jv SEEPAGE PIT RaIhFiELD
EXiN..CE SPOOL,DRYWE_L,MANBOLE Cn_ S 2.00 CQ. IMP. NO. .I OB NO.
HOUSE SEWER CONNECTING TO I
I PRIVATE DISPOSAL SYSTEM I<-' ,9.00 k TRUNK PERMIT NO. ROAD PERMIT NO.
�. CONNECT ADDITIONAL BLDG.OR }.. I STATE ENCROACHME14T w
.j
WORK'TO HOUSE SEWER .1� 31.00 .dd� ��' PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE i INDUSTRIAL
SEWER OR DISPOSAL SYSTEM. r $1.00
--� - - ---- ---- ---- --- l -..__.'----- WASTE APPROVAL.
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT1 00 ----------.__—_
- --'-'- -- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE c% �yt+YY f
�
[ .HAVE AT THISAPPROVALS DATE INSPECTOR'SSIG'NATURE'. DATE A CONTRACT WITH THE HEREIN NAMED CON- __-
SIGNEI3r'iHtSC SEWER.
OF DESCRIBED EXISTING DWELLING
TRACTOR TO CONNECT THE: ABOVE DES
`p _ NEW HOUSE SEYVEF2 I _
I9---- CONNECT ADDITIONAL
OWNER OR k
BUILDING OR_WORK I. ----.
t.a"+..�.
OWNERS SEPTIC TANK.SEEP,PIT(S) �--' t ------`--'—
_ADDRESS-- AND/ORDRAiNr'ELD ,I -_
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL . DRYW.ELL[j AN STATE THAT THE ABOVE i5 COR.RECT AND .AGREE TO COMPLX _
Wi"TH ALL COU'NTY ORDINANCES AND STATE LAWS REGULATIN;t ALTER,REPAIR,SEWER OR
PLUMBING AN','U SEWERS y' 1 __SEWAGE DISPOSAL SYSTEM
I HEREBY ERTiFY THAT A AM PROPERLY REGISTERED ANDAR ---�T_--`----"--- - "---`---T--'--"- ;
�I DISCONNECT PLUG AND 1
i` A REQUIRED 3t' LT ANGELES COUNTY AND STATE F ABANDON HOUSE SEWER I
CALF NIA•OR THAT I A THE LEGAL2,0 ER
CALIF7H. AS VE
DES IBED ESiDENTIALiPR Y. 't� 'I BACKFILL SEPTIC.TANKS `
` . SEEP.PIT(Sj D CESSPOOLS 0 -
_—
tOH(V A. LAN(WE, COUNTY ENGINEER VALIDATICj = ROEERT A. WOOD,CHIEF PLEIG. INSPECTOR
CASH
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