HomeMy Public PortalAbout4846 WILLMONTE AVE_Sewer__ 7SA642Dr APPLICATION FOR PERMIT 1
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B III RDI N 6 77]-
FOR
JOHN A. LAMBIE, County EngineerADDRESS �dYs-CASSATT D. GRIFFIN, Supt of Building LOCALITYNEAREST s APPLICANT TO FILL IN CROSSS
LEGAL a d'N' J er
DESCRIPTION LOT NO OWNER k �d �' � t ✓ °3:I�r�rj .�
BLOCK TRACT MAIL
a ADDRESS
ISO.OF BLDGS. _
SITE OF LOT`" NOW ON LOT CITY TEL.N0.
USE OF
BUILDINGS , �r�� DISTRICT NO:. GROIiP MAP PROCESSED BY
CONTRACTOR - BK PG
ADDRESS .,� j= , CONNECTION DATA re
CITY./?/? •._ TEL.NO'f 3 STATION DEPTx
y y v -� ❑ .STATE MANHOLE REFERENCE ✓
REGISTRATION NO, ✓ ;s ❑ COUNTY
NO. ! DESCRIPTION OF WORK � FEE
I ROUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 -
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM s
PITS AND/OR DRAINFIELD $3.00 Y. CURB P.L. M,L.TO P,L,
OVERFLOW SEEPAGE PIT.DRAINFIELD -
EXTN.,CESSP0OL,DRYWELLMANHOLE @ $2.00
HOUSE SEWER CONNECTING TO J P.C.NO,
PRIVATE DISPOSAL SYSTEM' @ $1.00 CO.IMF.NO. 30B NO.
CONNECT ADDI71DNAL BLDG,OR TRUNK PRMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER $1.00 E-,
ALTER,REPAIR OR ABANDON HOUSE STATE ENCRIIACHMENT
SEWER OR DISPOSAL SYSTEM $1.'06 PERMIT N0. "4.,
INDUSTRIAL
WASTE APPROVAL
" CHA
OWNER'S PERMIT 8 E 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER,
SIGNED THIS DAY OF NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP,PIT(S)
ADDRESSAND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 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 Of PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE r _ SEEP.PIT(S) ❑ CESSPOOLS[IOF PERXITTE
VAIMATION,-- ROBER'T'A.WOOD
S& r.4, ,-'cum SUPERVISING MECHANICAL,ENGINEER
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