HomeMy Public PortalAbout4841 WILLMONTE AVE_Sewer__ DEP"TIY w OF COUNTY ENGnv = • ' SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY . PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
FOR APPLICANT TO LL IN LOCALITY
BUILDING /f
A'DDRE� ! '� � 1 �rl� •gypi�6J1 ACROSS ST.
LOCALITY b/• f'� DISTRICT NO. SERIAL NO. PERMIT NO:
NEAREST o• A iL S
CROSS ST. A � _ BEC IVED-8 01 Ready Tor Inepeatian D /E ISSUED'
OWNER /1ni. /Ir+•�
MAIL �O +$1 USE ZONES OCCUPANCY BAoERP�
ADDRESS i
CITY � � TEL.
t
CONTRACTOR �90JMP.N0. A,;
ADDRESS /.. ?�� -Lad ! JOB N0.
CITY �` TELAO. �i G/ b 3 TRUNK PERMIT NO.
REGISTRATION N0. /��`�.,sSTATE
� ` �- ® CO NTY ROAD PERMIT N0.
SCRf '
DESCRIPTION TNs
STATE ENCROACHMENT------------;-
PERMIT
NCROACHMENTPERMIT NO.
BLOCK TRACT INDUSTRIAL
{ -WASTE APPROVAL
SIZE OF LOT/0a,r (/NOW ON LOTS'
CHARGE
USE OF
BUILDINGS A CONNECTION CE FEE
f �, H G
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 C RECEIPT N0, •DATE I BY
HOUSE SEWER.CONNECTING.TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDO..OR ' EXCEPTION REC RDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER Y
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION ® DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY2.00 ANHOLE REFERENCE
_TS3?P�PR LOWE )
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 a1� •'Q� L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR' ' IGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_... __...DAX O.F_.._._...._...__..._.—_.19_—_ 'NEW HOUSE SEWER t .A
ER OR
-CONNECT ADDITIONAL
ERS AGENT......._.._.
"BUILDING OR WORK
OWN
ADDRESS---__.._...-_.... d/ AND/OR DRAINF ELD PIT(S)
1 HEREBY ACKNOWLEDGE.THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL E]
CATION AND STATE THAT THE ABOVE I8 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
AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ;ABANDON NOOSE SEWER
AND STATE OF CALIFORNIA OR THAT i AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SIGNATURE SEEP.PIT(S)[] CESSPOOLS
OF
70A048A 663 7/53