HomeMy Public PortalAbout4825 WILLMONTE AVE_Sewer__ ' 808 8 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 7157
I0HN A. LAMBIE, County Engineer ADDRESS :5 8 t
CASSAIT D. GRIFFIN, Sup t of Building LOCALITY t"
FOR APPLICANT TO FILL IN CRO�SST.
NEAREST
LEGAL
—DESCRIPTION LOT N0.S6 OWNER
2/ / �,�tl C i�'
BLOCK TRACTillf MAIL
ADDRESS
`'� NO.OF BLDGS.
SIZE OF LOT 3 eB NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS `. DISTRICT NO, GROUP MAP PROCESSED BIS
1 BK PG
CONTRACTOR
ADDRESS , _ CONNECTION DATA
CITY TEL.N0. Qg` STATION ` DEPTH
y�y STATE— MANHOLE REFERENCE UPPER
REGISTRATION N0. ra�r 4. >1s� ao- flYk
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER CD $8.00 TYPE OF CONNECTION LENGTH FROM v
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS_AND/ORDRAINFIELD t S8.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXT'N.,CESSPOOL, DRYWELL $2.00
HOUSE SEWER CONNECTING,TOP.C.N.O.
PRIVATE DISPOSAL SYSTEM - @ $1.00 CO.IMP. ND.'.,�' �J JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK.PERMIT N0. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
r EPAIR OR ABANDON HOUSE T
ALTER.`: STATE ENCROACH#AsfdT.
PERMITNO.
SEWER OR DISPOSAL SYSTEM @ $1.00 NO
. ----
INDUSTRIAL - _ -
WASTE APPROVAL
CHARGES
OWN'EWS PERMIT $ 2 00 CONNECTION,CHARGE FEE
AUTI'IORIZATION TOTAL FEE :!�_lzt REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE, INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY O 19— NEW HOUSE SEWER _ I
OWNER OR CONNECT CONNECT ADDITIONAL F I
OWNERS AGENT lei -- BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 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 PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND �a
LICENSED AS REQUIRED BY LOS ANG ES COUNTY A I. OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM E G I NER ABOVE
DESCRIBED D L PR Y. BACKrIP. L SSEPTIC CESSPOOLS ❑
SIGNATURE '� -
OF PC MITT ;E7 --
bF7ALMATION ROBERT A. WOOD
,!CK. U.0.- CASH SUPERVISING MECHANIC:AL.. ENGINEER