HomeMy Public PortalAbout4850 WILLMONTE AVE_Sewer__ °
09808- APPLICATION FOR PERMIT
ssos-s-ss. COUNTY OF LOS ANGELES
~JEWER—Jr` EWAGE DISPOSAL
1 DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILD SG771
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JOHN JL LAMBIE, County Engineer
CASSATT D. GRIFFIN. Supt of Building � '
P g LOCALITY
FOR APPLICANT TO FILL IN doss sr. .`° rr6 >'
LEGAL
D
ESCRIPTION LOT N0. F's J ✓ CR
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LOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
OF LOT NOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
9Y. PO
CONTRACTOR
$ - —'
ADDRESS CONNECTION DATA
CITY a TEL: STATION 1 '. r DEPTH
[J STATE MANHOLE REFERENCE
REGISTRATION N0. a °TF
`g ❑ COUNTY ,.? �J t ' LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3°00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P,L,, M.L,Tfl P.L.
PITS AND/OR DRAINFIELD 0 $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN„CESSPOOL,DRYWELL,MANHOLE @ $2,00
HOUSE SEWER CONNECTING TOP.
C.
N0.
PRIVATE DISPOSAL SYSTEM a $1.00 CO.IMP,NO. i'y JOB N0.
CONNECT ADDITIONAL BLDG,OR TRUNK PERMIT NO. ROAD PERMIT NO.-
WORK TO HOUSE SEINER 0& $1.00
ALTER:REPAIR OR ABANDONHOUSE STATE EFdCROACHfiIEI3T`
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT NO.
INDUSTRIAL
WASTEAPPROVAI
r _.
CHARGES
OV MT HS PERMIT $ 2 OO 'CONNECTION CHARGE FEE
AUTHORIZATION I 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 SEINER..
SIGNED THIS DAY OF 19_i NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL;
OWNERS AGENT I' ' BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL[] DR'YWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT II AM PROPERLY REGISTERED AND/OR DISCONNECT 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[I
s SEEP.PIT(S) [1 CESSPOOLS
SIGNATURE' `7 <'-. w f✓ s
OF PERMITTE W
'p VALWATIONROBERT A.WOOD
■.a. eACIt 9 '' SUPRIRVI oIAIO MECHANICAL ENGINEER