HomeMy Public PortalAbout4816 WILLMONTE AVE_Sewer__ D
1808.s-�e APPLICATION FOR PERMIT 1
:ssos. COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION au IN {�
JOHN A. LAMBIE, County Engineer ADDRESS gy
CASSAIT D. GRIFFIN,Supt oi.Building LOCALITY
FOR APPLICAM TO cNROSS sr.�'�
LEGAL0.
p r""
DESCRIPTION LOT N x 6WNER
BLOCK TRACT -}aa ` e MAIL
ADDRESS '`_
NO,OF BLDGS,
SIZE OF LOT NOW ON LOT 31 CITY TEL.NO_
USE OF
BUILDINGS��' sy L—a'� � _' _ DISTRICT NO. GROUP ASAP PROCESSED BY
BK PG
CONTRACTOR d # � }" Z .^ t q
ADDRESS -� l y, �r� �, CO ECTIO DATA
CITY N0. STATION ''.? � DEPTHSTATE t
REGISTRATION N'0. � COUNTY MANHOLE REFERENCE , 1 pPE
NO—J- ISE—SCRRIPTION OF WORD— FEE .9'
A
HOUSE SEWER CONNECTING TO y
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION,- LENGTH FROM
PITS AND/OR DRAINFIELD $3.00 CURB L. M.L.TO P.L. •- ��_T
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,,ESSPOOL,DRYWELL,MAN HOLE @_$2.00
HOUSE, SEWER CONNECTING TO �+ p 4y` P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0. JOB NO.
K ---
CONNECT RTT@ADDITIONAL BLDG.OR TRUNK PERMIT N0: ROAD PERMIT N0.
WORK O HOUSE SEWER $1_00 -� - �� _ _
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM 0 $1.00 PERMIT-NO. -
INDUSTRIAL
4WASTE APPROVAL * a e,
_ CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE � �f:_ ;�� REIMBURSE14ENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS GATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNER THIS DA, QF I g� NEW HOUSE SEWER
OWNER OR t-,�, CONNECT ADDITIONAL "—."_..r._—�..._..�,._.-
OWNERS AGENT l BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS< SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERXY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELS COUNTY AND ATH OF ABANDON HOUSE SEWER
(IALIFOR A OR THAT AIS
z AM THE LE " OWNER OF VE -
CRiBD RESIDENTIYt-..iP,ROPERTY BACKFILL SEPTIC TANKS
r SEEP, PIT(S) ❑ CESSPOOLS[Isl I
gyp. VA ATIO ROBERT A.WOOD
CASH SUPERVISING MECHANICAL ENGINEER