HomeMy Public PortalAbout4919 WILLMONTE AVE_Sewer__ rBAga APPLICATION FOR PERMIT 1
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-8-a.ss COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY' ENGINEER
BUILDING AND SAFETY DIVISION BUILDING '' o
JOHN A. LAMBI£, County Eags'a®ar ADDRESS r r
CASSATT D. GRIFFIN, Supt of Building
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST,
LEGAL .J ." OWNER L-I d
DESCRIPTION LCT 0.
BLOCKTRACT ` ° ' MAIL
dI'� ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL,NO.
USE OF € M
BUILDINGS DISTRICT N0. GROUP MAP PR6ESSED BY
SK PG
CONTRACTOR:
ADDRESS�/
4CACONNECTION DATA
CITY y t TEL N0, 4" STATION � � DEPTH
9f'ATE
COUNTY MANHOLEREFERENCE {' s
REGISTRATION NO,
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
TYPE OF CONNECTION LENGTH FROM g/
PITSTANK,SEEPAGE PIT OR Y. CURB P L.Y M.L.TO P>L. -
PITS AND/OR DRAINi�1ELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,C'"SSPOOL,DRYWELL,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TO � �� ry; P,C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0. r� JOB NO.
CONNECT ADDITIONAL,BLDG.OR TRUNK PERMIT N0, ROAD PERMIT NO,
WORK TO HOUSE SEWER @ $1,00
ALTER,REPAIR OR ABANDON HOUSE STATE EN
.�-'..�
C1tCtgMEN1 � �
SEWER OR DISPOSAL SYSTEM 00 PERMIT NO,
INDUSTRIAL
WASTE APPRO
CHARGES
OWNER" PERMIT 3 2 00 CONNECTION CHARGE FEE
Ott tn�r�c w-�
AUTHORIZATION TOTAL FEE � !,r'D 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 nAY OF 19_ NEW HOUSE SEWER
OWNER OR " CONNECT ADDITIONAL
OWNERS Ria BUILDING OR WORK
AGENT-
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY crssPOOL_D DRYWELL Q
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 ABANDON HOUSE SEWER
CALIFORNIA OR THAT "I AM THE LEGAL O)VNER OF THE ABOVE BACKFILL C TANK5
DESCRIBED RESIDiI fRQPERTY
SIGNATURE 6' ¢ ,, SEEP.PITS)SEPTICESSPOOLS_[]
OF PERMITTE ^
VALIDATION,. ,, RO BERT A.WOOD
*mgeK. M.96 mg SUPERVISING MECIiANICAL ENGINEER
E-6 Ll69 11.5953& APPLICATION FOR PERMIT
S =fs -
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING `' - _
JOHN A. LAMBIE. COUNTY ENGINEER _ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING ✓ ,
LOC.4LSTYST
t
FOR APPLICANT TO FILL IN CROSS .
LEGAL OWNER
DESCRIPTION -LOT NO. ;, - _
TRACT
BLOCK •� Y-��`: MAILADDR
c3 � ESS
NO.OF BLDGS. x
SIZE OF LOT NOW ON LOT CITY y., . 4'._,. TEL. N0
- USE OF — DISTRICT MGRMAP
BK PG
BUILDINGST0. OUP_ ICT
CONTRACTORE'�,.
t CONNECTION DATA
ADDRESS --- - --- -----
f STATION �� DEPTH _
CITY j p; F _ _TEL. NO. a '' P '„ MANHOLE REFERENCE. �f ,t — -tam� O_WER
TATE L,
a� _
REGISTRATION NO. �-x ` COUNTY --�
_ _ _ _ __ .y _
NO, 1 DESCRIPTION OF WORKT FEE — -- ------ --
-` - -- ---- - - •�.-..,"pTYPE OF,CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO i Y. _. M,L.TO P.L. e,;>�
PUBLIC SEWER _ $ 3.SO _�-, --
SEPTIC TANK SEEPAGE PIT OR
PITS ANDiOR DRAINFIELD
I, OVERFLOW SEEPAGE PIT,DPAINFIELD _ ,✓' .�r,�- C.NO.
EXi,I.,CE55PO0L,pRY-W EL L,MAN H0 LE �cfi $,�..c70 t:0. IME' NO. y� '�-- JOB NO. �r
-
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Yc __ ,,e
S 1.Q0� -� IR N0. _ R09D PERMIT NO��{��_
CONNECT ADDITIONAL BLDG.OR I r STATE ENCROACHMENT
WORK TO HOUSE SEWER ((-v $1.OU I PERMIT NO.
--I- -- —--- ---- ---- ---- {- ---
i ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
i. EWER OR DISPOSAL SYSTEM �I� $1.03 I WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S I 1 GO - - ------------------------- ---
- -- I REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE � � y- �tsf ac �+
i�
3
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• APPROVALS DATE INSPECTOR SSiGNATURE
TRACT'OR TO CONNECT T'HE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS--- _PAY 0 --- - �—� CONNECT ADDITIONAL - -- - --
F
OWNER OR ._DUILDNNG OR WORK _
--- ----
OWNERS Ar ', -�
.GENTh _*_� � r EPTIC7HNK SEEP, PIT(S)
ND/SLR DRAIN FLD
HEREBY ACKNOWLEDGC THAT I HAVE READ THIS APPLICATION CESSPOOL[] DRYWELLEj
AND STATE THAT "HE ABOVE !S CORRECT AND AGREE TO COMPLY
W
iTH ALL COUNTY O.WN'ANCES AND STATE LAWS REGULATING ALTER,.REPAIR,SEWER OR �
PLUMSSNG AND SEWERS, SEWAGE DISPOSALSYSTEM i
I HERERY CERTIFY THAT ' ,AM PROPERLY REGISTERED AND/QR
LICENSED P.S REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I Abt, THE LEGAL OWNER OF THE ABOVE _ABANDON HCUSE SEWER
DESCRIBED RESIDENTIAL PR EP,TY. eACKF1LL SEPTIC TANKS`]
SEEP PL"S) CESSPOOLS
SIGNATURE, l.___----..,--.---__--
OF PERMITTEE
JOHN A. LA BIE, CO VKTY ENGINEER --VALIDATION ROBERT A.WOOD, CHIEF f LBG. INSPECTOR
0. GASH - 4
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