HomeMy Public PortalAbout4916 WILLMONTE AVE_Sewer__ 70AS420
CE608 11-57 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 40,16 Willm.onte
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building 'eralple ".i-4-y
LOCALITY
NEAREST
FOR, APPLICANT TO FILL IN _�ROS�ST.
LEGAL Weber _Coriul 0-
DESCRIPTION LOT NO) 20 OWNER loftruc-i n .5
1-104b Al
,BLOCK TRACT'
'_ADDRESS 2?26 S'an Gabriel Blvd.
NO.OF BLDGS,
SIZE OF LOT NOW ON LOT CITY San Gabrie'TEL.110,
USEOF
DESCRIPTION
Residence DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR
ADDRESS Box 2� Col TION DATA
CITY Baldwin Par.-, TEL.NO. Ed. 83r224 STATION DEPTH
I , 7� STATE MANHOLE REFERENCE
REGISTRATION NO. COUNTY
i�LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
41- PUBLIC SEWER @ $3.50 _100 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR '4�.L
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB M.L.TO P.L. 2 ki�
OVERFLOW SEEPAGE PIT DRAINFIELD
EX�.7N.,CESSPE)OL.DRY�'iE'l.L,MANiiOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 Co.IMP. NO. 0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00
_6_k_A_—- TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
_WASTE APPROVAL CHARGES
OWNER'S PERMIT $ LT oo CONNECTION CHARGE FEE
AUTHORIZATION� TOTAL FEE 51100— REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DkTE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS_ DAY OF —I 9 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT Dew BUI LDI NG OR WORK
ADDRESS- SEPTIC TANK,SEEP,PIT(5)
AND/OR DRAINFIELD
CON'
ADDI
CITY
r
,I
0.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
AND/OR —SEWAGE DISPOSAL.SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED W�_E_
LICE NSED AS REQUIREO BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM, THE LEGAL OWNER OF THE ABOVE '
ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL
SEPTCTA
KS0
SEEP.PIT(S) dCESSp..LS
SIGNATURE
OFFERMITTEE
-MALIDATION ROBERT A. WOOD
c CK. X.01 CASH SUPERVISING MECkiANICAL,ENGINEER
"
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