HomeMy Public PortalAbout4913 WILLMONTE AVE_Sewer__ OA642D
E808 8.59 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRBUILDING ESS
JOHN A. LANIBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
, NEAEST
F RAPLCANT CRO
ST. Z��e.t
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT
NOW ON LOT CITY TEL. NO.
USE OF
_2MI-DINGS ✓ DISTRICT NO. GROUP MAP PROCESSED BY
EK PG
CONTRACTOR
ADDRESS �7
CONNECTION DATA
---
--DEFTH
CITY TEL.NO. STATION
4�
7 STATE MANHOLE REFERENCE "PV-R-
TE_94E_M_P0_f4 NO. COUNTY i LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3.00 _,�y .4
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTIONLENGTI FROM
CURB 7 P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRA.!NFIELD
EXTN4. CESSPOOL,DRYWELL $2,00
HOUSE SEWER CONNECTING TO
P.C,NO,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. OB NO.
CONNECT ADDITIONAL BLDG,OR PERMIT No.
p
WORK TO_HOUSE SEWER - - - x1.00 1 TRUNK PERMIT NO. ROAD
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL, CHARGES
OWNER'S PERMT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER, DATE INSPECTOR'S SIGNATURE
SIGNED THIS D OF=� 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT- BUILDING OR WORK
ADDRESS-- ✓ SEPTIC TANK.SEEP.PIT(S)
AND/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 DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE __,�BAIIDON HOUSE SEWER
DESCRIBED RE IDE BACKFILL SEPTIC TANKS
,;iTIAL PROPERTY.
SEEP.PIT(S) 0 CESSPOOLS E_j
SIGNATURE
OF PERMITTEE
Jr VALIDATION- ROBERT A. WOOD
CK. M.0. GASH SUPERVISING MECHANICAL ENGINEER
76A
E-663 fS•55 APPLICATION FOR PERMIT 1
S&E-6 H
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS '
ED CASS,AT'T D.GRIFFIN, SUPT of BUILDING LOCALITY
EST ✓ � .� ;P
FOR APPLICANT TO FILL IN NEAREST
LEGAL------�--- ,. ;
DESCRIPTION L07 NO `�— OWNER
MAIL
BLOCK
-- TRAADDRESS --
NO.OF BLDGS.
CITY �.; TEL. �'.:'-,�
SIZE 0€LOT NOW ON LOT i ' `
USE OF —_ -- —� - —
_BUTLDI'NGS DISTRICT NO, GROUP MAP
-
—_ —
BK PG
CONTRACTOR �` , V �� .:r"'.�,_,..e
CONNECTION DATA
ADDRESS
STATION - DEPTH
CITYEL. NC
MANHOLE REFERENCE_ �-�" -.
f STATE ------ENC ` ZL..__)ER
W
REGISTRATION NO. ' Q COUNTY --.
NO. DESCRIPtION OF WORK - FEE ------- ----- ----- — — —
r HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM t/
J l PUBLIC SEWER @ $3.50 -( I -+! _Y• CURB ,'IP:L,T� M.L.TO P.L_ "
SEPTIC TANK SEEPAGE PIT OR f , �.r , p� 6 _ 30' .i
PITS
_j AND OR DRAINFIELD C $^.00 a �
OVERFLOW SEEPAGE PIT DRAINFIF•.LD 'r'r P. C. 40. �, d
-.,_i FXTN.,CESSP00,L,DRYWELL_MANH0LE {t $2_00 1CO. IMP. NO. —JOB NO.
I
HOUSESEWERCONNECTING TO -
! PRIVATE DISPOSAL SYSTEM _--- (n 5 i.00 - TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER L% c t.OU ! PERMIT NO.
!
ALTER,REPAIR OR ABANDON HOUSE --
- -----.__—.
EvY'Ek OR DISPOSAL SYSTEM /i. $1.0v INDUSTRIAL
_. WASTE APPROVAL
CHARGES
CONNECTION CHARGE
OWNER'S MIT PER -- __- _.-.-----._
_ _
AUTHORIZATION TOTAL. FEE -}— REIMBURSEMENT FEE
;
I HAVE A1' IHtS DATE A CONTRACT WITH THE HEREIN NAMED CON= APPROVAL S DATE 1NSPECTCP'S SiGIdATURE__-_ I
TR.ACTCR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWERSIGNED !
_dF -^=' --1 .------ CONNECT ADDITIONAL ! �-
OWNER ; BUILDING OR WORK -
OWNERS ARENI Y1', DAY - --_-------
'- __..-
'_ .---- SEPTIC TANK,.SEEP,PIT(S)
AuDRESS AND/OR GRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE REP-D THIS APPLICATION CESSPOOLL] DRYWELL
AND STATE T} T IHE AB VE S CORRE CI AND AGREE TO COMPLY
V ITP ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR I
PLUMBING AILD SEWERS. SEWAGE DISPOSAL SYSTEM
I tiEPi BY CERTIFY THAT I AM PROPERLY REGISTERED AND%OR ---------
LICE§5ED �'-.S REq U!RED BY 1.05 ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I hi THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL OPER7Y. r' - BACKFILL SEPTIC TANKS❑
SiGNhTURE SEEP PIT(S) LI CESSPOOLS
r,J
--..... _.'----- -----
OF PERMITTEE i
JOHN A. LAMBIE, C NTY ENGINEER 1--('LIBATION ROSERI A.WOOD, CHIEF PLBG. INSPECTOR
CK, 5[.O. CASH
c'
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