HomeMy Public PortalAbout4840 WILLMONTE AVE_Sewer__ 76i K4aD
3:s6 APPLICATION FOR PERMIT
%DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILD SG +
WM.J. FOX.COUNTY ENGINEER —ADDRE
--
CA.SSATT D.GRIFFIN,SUPT OF BUILCING
LOCALITY
FOR APPLICANT TO FILL IN CROSS
ST. ,
LEGAL - Y ,'dry' .,�,_� r y _
DESCRIPTION LOT NO. � �.lr., t
BLOCK TRACTm ° ,-� x -' MAIL
ADDRESS
SIZE OF LOr..�, e E.,� NO. OF BLDGS. rx �, -
,�'- NOW ON LOT _ CITY ,,d'" . "TE N0. e
USE OF �66
BUILUtNGS .I.+' DISTRICT NO,
G UP MAP
y BR EC
CONTRACTOR
_ _ __�✓ __ _ __ ___ ,dam
ADDRESS �` — - CONNECTION DATA f
--—
CITY _L,:( - �! .`� TEL. NO.,T'� g a d �`'� STATION�-, i '� DEPTH _
'STATE` MANHOLE REFERENCE ➢y ' m
REGISTRATION N0. 1>` fo" °k� G COUNTY 4. �� _� 4 LOWER_
Na. DESCRIPTION of WORK FEET� _ ----- -------- __-
I;SE SEWFR CR•a^aECtING TO - - ',-� j.
TYPE aF
ISO
CONNECTION LENGTH FROM
S WER �ry $ 3.501 `X , . y--, -- CURB P.L. h4L. '70P_L.—
I
HOUSE SEWER TING TO
PRdV,4TE DISPOSAL
L S fSTEM 5,00 ---
CONNECT ADDITIONAL BLDG. OR ` T ✓ - - P C. N0.
0 K TO HOUSE SLWER
_—
1—.00
ALTER OR REPAIR EXIST NG
RCRDISPOSALrSTEM
—
3,00. TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON STATE ENCROACHMENT`_
--
AND/OR OR DIs?OSAL SYSTEM 1.00 _ _ PERMIT NO.
^� SEPTIC TANK SEEPAGE PIT CR --' -- - --- — —'--------------_.._-
-_J PITS AND/OR G_RAINFIEL_U_— .00 INDUSTRIAL
_
CESSPOOL DRYW£LL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00l CHARGES
OWNER'S PERMIT ..-- --� - CONNECTIONCHARGE FEE
- ---- --
_.S i i 00
AUTHORIZATIONTOTAL FEE � REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH Tri° HEREIN NAI D CON- R `y Tom! E
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECT('iR�S.�riGNATURE
TO THE PUBLIC' SEWS Y '- - —�— -- ---
1 NEW HOUSE SE;'fER—
SIGNED THIS DAY OF
OWNER ORw' .. w �•.�"� CONNECT ADDITIONAL
OWNERS AGENT._. ...�t` '' '` (t" .r BUILDING ORWORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS '� _ __—_�--.-- AND/OR DRAI_NFIELD-- _ —
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION— CESSPOOL 0 DRYWELL[7,1AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEA-VER£R OR —.
PLUMBI"{G AND SEWERS. ALTER,
DISPOSAL SYS"TGM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/CR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE, LEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[;
4 �_� _SEEP. PITS) L7 CESSPOOLS
SlOF PERMITTEE —
WILLIAM J.FOX.COUNTY ENGINEER VA MATION R.A.WOOD, CHIEF PLBG. INSPECTOR