HomeMy Public PortalAbout4837 WILLMONTE AVE_Sewer__ DEPAIVI'DEENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY- PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J.-FOX, COUNTY ENGINEER I BUILDING //'Q_ 7 ®ZZ�®�7E
A':DDRE8S �f(j E'�
FOR APPLICANT T9 !lL IN LOCALITYBUILDING B fNEAREST
ADDRESS CROSS ST.
LOCALITY -DISTRICT NO. SERIAL NO. PERMIT NO.
C
NEAREST t_,Q I /17 J
CROSS ST.
y� RECEIVED 8Ready for Inspection D XE ISSU�D^-A/°
OWNERMAIL
ADDRESS "� i� -` I -USEZO OCCUPANCY /. '}MSP--•
- g BIC PG
CITY TEL.N -
_ v
CONTRACTORa `r ,e � � CO.IMP.N0.
ADDRESS I^ G/V . ffJfl.�Sl _ fj .h JOB NO.
CITY w r it TELAO. TRUNK PERMIT NO.
lea ❑❑ STATE
REGISTRATION NO, /-. � � 3 .��w .p-CO.U.N-•'EY; ROAD PERMIT NO.
LEGAL a ' s` G •4�a
DESCRIPTION LOT N0. - "STATE ENCROACHMENT
�•�� - •� �— .PERMIT N0. _
BLOCK TRACT ;INDUSTRIAL
,�7 �g WASTE APPROVAL _
SIZE OF LOT f�Q ,35 NOW ON LOT wl+ CHARGES
USE OF ee�,
BUILDINGS vs" .rte +- ( � CONNECTION CHARG`EEE.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.507 RECEIPT N0. NTE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00.
CONNECT ADDITIONAL BLDG.OR ._ EXCEPTION RE DED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIREXISTING NO. I DATE \I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 -, CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00I STATION . DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 'r 2 MAIN LE REFERENCE
✓ 44 OW E
TYPE OF COHFtiCT10 — LENGTH FROA(.
OWNERS PERMIT ;, 1 00.1 P.I M.L.TO P.L.L
AUTHORIZATION TOTAL FEE -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR;8 INSPECTOR; SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS...._._..__...._DAY _ 19 NEW HOUSE SEWERp�r„
OWNER " OR CONNECT ADDITIONAL _
OWNERS AGENT.....••_...._.. BUILDING OR WORK
Com` SEPTIC TANK,SEEP.PIT(S)
ADDRESS..._......__._..._ .._..
...........
AND/OR AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I.HAVE READ THIS APPLI: CESSPOOL[] DRYWELL
CATIONAND 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED- DISCONNECT PLUG AND
A'ND/OR LIOENSED•AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE S EWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED-RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
_ _ SEEP.PIT(S)(] .CESSPOOLS
SIGNATURE J -
OF PERMITTEE .. .._._..!...._._._.._ �._.._._..:..._..�:.__._.,_..
76A642A 660 7/53.