HomeMy Public PortalAbout4847 WILLMONTE AVE_Sewer__ iS E:.66 APPLICATION FOR PERMIT 1
S&E•663 PY•55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles sUli_DING ;
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS" .� �✓ f.l t sy. f.-6 :,
CASSATT D.GRIFFIN, SUPT of BUILDING
LOCALITY
NEAREST. eyw s-
- FOR APPLICANT TO FILL IN ceoss
LEGAL---- - r'`..y+ t OWNER
DESIP
CRTION LOT'NO,p.
BLOCK TRACCT- / / MAIL
- ADDRESS _ ;�^;,yr '' -. ,J •
_SIZE OF LOT _ NOW ON LOT CITY - -"'y TEL. N0.
USE OF —
BUILDINGS e s � DISTRICT NO.. GROUP j MAP
BK PG
CONTRACTU:R�°
ADDRESS ' CONNECTION DATA
I _ , DEPTH
CITY �7, r �-"' TEL. N0. � �",.eA '�- __STATION i— :--
-- MANHOLE REFERENCE J ✓ �t�>' -
Y Q STATE
REGISTRATION N.O. [I -COUNTY
_ 0-- �
No_-' DESCRIPTION 00 K' FEE -- -HOUSE SEWER CONNECTING C0� TYPE OF CONNECTION LENGTH FROM
—SCJ--, PUBLIC SEWER _ _ v $ 50 I_ T+•t,,,—. Y_-_--- CURB _.L. M.L.TO P.L.. _ --
SEPTIC TANK SEEPAGE PIT OR f b
j PITS AND/OR DRAINFIELD_ (a% $ 0
- OVERFLOW SEEPAGE PIT,DRAINFIELD 3.0��—
EXIN.,CESSPOOL,DRYWELL,MANHOLE 5i _$2.00 CO.. IMP. N0,
I HOUSE SEWER CONNECTING TO --- - A!I ---- �MA
PkIVATE D SPOSAL SYS"CEM R $1.00 I __ ROADPERMIT N0CONNECT ADDITIONAL BLDG,ORSTAENT —
WORK TO HOUSE SEWER a _
-_---_ "--- --_-. -- C S 1.00 ---_ _PERMIT N0. vim.
ALTER,REPAIR OR ABANDON HOUSE
INDUSTRIAL
r
SEWER OR DISPOSAL SYSTEM [ _ 0 -
_ . .WASTE APPROVAL
��� .-x1.-is- 'F��I.:r;9 °l�''��i� � � � r'"--�� �1✓� �"s.-___ �'C-'i.N x. ' -_."
w _
,f-.-^' — ------ -- CEA4'L1kGc FEE
® NER°S PERMIT � 1 00 / $.�'",a�,,�� ,"` �_AUTHORIZATION ORIZATION TOTAL FEE - a — iMBURSEtTE It't'EE �e, 0
APPROVALS "� l DATE INSPECTOR S iC,. ATURE
I HAVE AT THIS DATE A CONTRACT WITHTHE 'HEREIN N'AM CON- _.-----------__----- ..—L_�.---- --- ._ _
TRA'-�OR. TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING j
TO THE PUBLIC SEWER - -NEW HOUSE SEWER. �. _
SIGNED THIS�_DAY OF_ __ 'v19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS FlCENT._ • - • • - - SEPTIC TANK,SEEP, PITS)
A.DD.R S AND/CR DRAINFIELD
' __ - _-- _. _ _._. _..— .. _.--
I HER Y ACKNOWL.€VGE THAT I HA READ _ - --
--- �-� THIS APPLICATION I`
CESSPOOL L] DRYLJELL❑
AND a7�.TF. Th THE ABOVE �5 COR;nCl AND AGREE TO COMPLY
WITH ALL. COUNTY ORDINAN�FS ANI. STATE LAWS REGULATING ALTER,REPAIR,SEWER OR y
PLUMBING AND SEtiERS, SEVJAGEDISPOSALSYSTEM
1 H
CERTIFY THAT I AM PROPERLY REGISTERED AND,/OR DISCONNECT PLUG AND I T
LIGE14N EFREEY) t,S Iz Q PFD BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE
CALIFOR,v�A OR THAI,' ! Ah"I THE LEGAL OWPIER O THE fY,BOVE --. -.. SEWER
DESCRIR_E'D RES! NTE`,j•PRO .M IACKF LL SEPTIC TANKS
f
' EEP T
PIS) L:j CESSPOOLS
`
C1
OF PERMIT'
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. MOOD. CHIEF PCBG, INSPECTOR
1 4 A 4.50 '