HomeMy Public PortalAbout4903 WILLMONTE AVE_Sewer__ raAaax® APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �:a
JOHN A. LAM M. County Finvineer ADDRESS r �Z fa -,
CASSATT D..GRIFFIN. Supt of Building LOCALITY
NEAREST
FOR SPP T ,_FILL IN CROSS ST. a a'
LEGAL •�Wy •
DESCRIPTION LOT NO. OWNER
BLOCK TRACT cMAIL
t .> 6 ADDRESS
SIZE OF LOT. y NO.OF BLDGS.NOW ON LOT CITY TEL,N0,
USE OF
BUILDINGS " GEIS-" DISTRICT ND. GROUP MAP PROCESSED BY
CONTRACYOR' ,r { — E3{ PG
ADDRESS , y� '� CONNECTION DATA
CITY ,ate¢ M y�;.6_ ;TEL. NO. ��_ �t' STATION DEPTH
REGISTRATION NO.' c ° ,' COUNTY-E STATE MANHOLE REFERENCE 6� ? UPPER
NO. 1 DESCRIPTION OF WORK FEE _ _ `~LOWER
HOUSE SEWER CONNECTING TO ;
PUBLIC SEWER @ $9.00 —
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS ANDIOR DRAINFIELD @ $9.00 Y. CURB P;I<, M.L.TO—PILI-1
OVERFLOW SEEPAGE PIT, DRAINFIELD
Ex_TN.,CE5Sp001-,DRYWELI.,NIAN40LE 0
HOUSE SEWER CONNECTING TO P.C,NO. — —
PRIVATE DISPOSAL SYSTEM $1,00 CO.IMP.NO. JbE NO,
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER 0 $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1,00 PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWN .. S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION FTOTAL FEE 5� y_ REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECT'OR'S SIGNATUI
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS—DY F° 1ST NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
u' SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL C1 DRYWELL Q
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
f HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CO'UNT'Y AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE IAL PROPERTY. "; BACKFILL SEPTIC TANKS
SIGNATURE i 6, k SEEP,PIT(S) [] CESSPOOLS[I
OF FERMITTf
,�rALIDATION ROBERT A.WOOD
CASH ' SUPERVISING MECHANICAL ENGINEER