HomeMy Public PortalAbout4836 WILLMONTE AVE_Sewer__ 1
S&E-6D �- APPLICATION FOR ..PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. !_A,7BIE, COUNTY ENGINEER ADDRESS -- t s' f
CASSATT D, GRIFFIN,.SUPT OF BUILDING
LOCALITY
FOR APPLIC ,NT, FILyL N doss sr. h� - —
LEGAL .,-�� 1'`:7'" - '-3-�--•d-��-�.�;.__ �•'
DESCRIPTION LOT Nd - OWNER --
--------- - #*_e MAIL
BLOCK - TRACT ADDRESS _ -
- NO.OF BLDGS. r
Sit£OF LOT NOW ON LOT CITY TEL NO.
OF
USE BUI �� --- — - ---
_LDIDINGS_.1._ /r °� 'r� `P � r Ut$TRICT NO. - I GROUP MAP
BK PG
CONTRACTOR
r`
ADDRESS CONNECTION DATA
� '� ���� � '��a< �� � — -- ---- ,---—
CITY '? r Et , N0. t - STATION DEPTH
,t` ( _ — --- ---- - ---
----- —_ -- -- ---- r MANHOLE REFERENCE vrrE
[] STATE - _,_-- rt LOWER'
REGISTRATION NO,
N0. DESCRIPTION OF WORK FEE --------.—._-------- -------- ---------.
_-`-F - ----- --------- -- ------- TYPE OF CONNECTION - LENGTH FROM
HOUSE SEWER CONNECTING TO F Y. CURB 'P.L.' M.L.TO P.L.
I PUBLIC SEWER -- -- - �_--- =.
SEPTIC TANK SEEPAGE A1T OR
PIIS AND/OR DRAINFIEL D_ C $3.0q
t —r---
I OVERFLOW SEEPAGE PST DR'AIN}jELD P C NO._ �
EX,N.,CESSPOOL,DRYWELL.MANHOLE 4-1) I �- CO. IMP, NO: JOS N0. —
$x.00 � -_ ;:
HOUSE SEWER CONNECIT-ING TO
_PRIVATE DISPOSAL SYSTEM r $1.00 TRUNK PERMIT NO. 'ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR ISTATE ENCROACHMENT
H '
!-WORK TO OUSE SEWER Ca, I.00 _ � - PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSEOR-DISPOSAL
SEWER OR DISPOSAL SYSTEM to 3 1.Oo � INDUSTRIAL j- _-._. __ _ _ WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT — � _
AUTHORIZATION TOTAL FEE $ - 00 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS j DATE 1INSPECTOR'SSIGNATGRE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING , ZL.
TO THE PUBLIC SEWER. NEW HOUSE SEWER I - -
SIGNED THIS DAY OF 19 S
CONNECT ADDITIONAL
OWNER OR - BULLRING OR WORK '
OWNERS AGENT SEPTIC TANK.,SEEP,PITS)
ADDRESS— - _ AND/OR DRAINFIELD_--..--_.- _...._._
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
CESSPOOL J DRYWELL[I
AND STATE THAT' THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEVERS. SEWAGE DISPOSAL SYSTEM I
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDONDISCONNECT
PLUG AND _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF IL HE .ABOVE
DESCRIBED RES IDENTI&L,.PROPERTY ' N` BACKFILL SEP-]C TANKS❑
SIGNATURE ^� 11 ' -------SEEP. NT(S) ❑ CESSPOOLS.(] -- --.- -----
..._—
OF PERMITTEE ' 4LL - _
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IOHN A. LAMBIE.COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
SCK. M.0, CA5H -.
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