HomeMy Public PortalAbout4907 WILLMONTE AVE_Sewer__ 78A$421) APPLICATION FOR PERMIT l
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineer ADDRESS g
CAMTT D. GRIAFIN. Supt of Building LOCALITY f.` `I -7
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. '
LEGAL 1:, ,` fi ! t. a
DESCRIPTION`' 0T NO OWNER ( d �✓ s N
BLOCK TRACT MAIL
ADDRESS $
,g- NO.OF BLDGS.
SIZE OF LOT 7 'j, '.' NOW ON LOT I CITY TEL.NO.
USE OF
BUILDINGS ,, ="gL� FR MAP I PROCESSED BY
CONTRACTOR'
Itrc I a !!
ADDRESS *' 7
,` CONNECTION DATA
CITY �' 'G .� 1✓ya TEL.NO. �^ y DEPTHREGISTRATION N0. I ,�. Y " ❑ COUNTYSTATE EUPPE✓No, ! DESCR MON OF WORK FEE ` —� _ LOWER
HOUSE SEWER CON14ECTING TOPUBLIC SEWER @ $3.00ECTION LENGTH FROM
SEPTIC TANK.SEEPAGE PIT OR P.L. IA.L. T P,1..
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
F.XTN.,CE55PO0L,DRYWEI.L,MAK)40LE @ $2.00 _
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. f JOB N0.
CONNECT ADDITIONAL BLDG.OR 'TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER I@ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM Q $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OYYNEWS PERMIT 2 ®0 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 ag_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT q— BUILDING OR WORK
ADDRESS " SEPTIC TANK:SEEP,PITS)
_AND/OR DRAINFIELD'
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATS THAT 'THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL [I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR.SEWER OR
PLUMBING AND SEWERS, SEWAGE DISFOSA.L SYSTEM
I HEREBY CERTIFY THAT I 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 RESID IAL PROPER'LT. "r BACKFILL SEPTIC TANKS❑
SIGNATURE / SEEP. PIT(S) Q CESSPOOLS
OF PERMITTE
® VALIDATION ROBERT A.WOOD
ct(. g.Gm GABS
SUPERVISING MECHANICAL ENGINEER