HomeMy Public PortalAbout4928 WILLMONTE AVE_Sewer__ 30811
fAPPLICATION FOR PERMIT
c 6oa 1l-s7 COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ,,� p�
JOHN A. LAMB1E, County Engineer
CASSATP D. GRIFFIN, Supt of Building erri l e '`L'i't
LITY "FOR APPLICANT TO FILL IN S ST.
LEGAL ✓ ,.-i( 3 vie er Construction C-0.
DESCRIPTION LOT N0. OWNERAIL a••�r�� q,, -f�
BLOCK TRACT ( - ADDRESS f t�f 4`,Il. Gabriel d a.3
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY San TEL.N0.
USE OF
BUILDINGS Residence DISTRICT NO. GROUP MAP
CONTRACTOR •-"a & Co. - BK PG
ADDRESS Box 208 CONNECTION DATA
CIT*Ei lG.wi Park rk TEL.No. i`d. 83024 STATION ;' . DEPTH —
7t STATE MANHOLE REFERENCE
REGISTRATION NO-1EfPIF-
)L7� COUNTY fr " LOWER
NO. 1 DESCRIPTION_WORK FEE
HOUSE SEWER CONNECTING TO ;Y
!
PUBLIC SEWER @ $3,50 ...+ 00 — s
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION,,•, LENGTH FROM
l
ITS AND/OR DRAINFIELD @ $3.00 Y. CURB P L.; M.L,TO P.L.
OVERFLOW SEEPAGE PIT'DRAINFIELD
EXTN.,CESSPOOL,DRY_WELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. ZIL JOB_NO,
CONNECT ADDITIONAL BLDG,OR — -
WORKTO HOUSE SEWER @. $1.00 _ TRUNK PERMIT N0.
ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE — -' -
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
1 I WASTE,APPROVAL
��T�,Y �+
CHARGES
OWNER'S PERMIT 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE �" 00 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DATE.. INSPECTOR'S"sIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS —_DAY OF ___g g____ NEW HOUSE SEWER
OWNER OR New CONNECT ADDITIONAL
OW14ERSAGENT. BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS_ _ _- -- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ. THIS APPLICATION
AND STATE. THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY CESSPOOL C1 DRYWELL 0 _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTEk,REPAIR,SE4VER OR
PLUMBING AND SEWERS.
1 HEREBY CERTIFY THAT I AM PROPERLY -REGISTERED AND/OR -- ----SEWAGE DISPOSAL SYSTEM L
SED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
ORNIA OR THAT I AM. THE LEGAL OWNER OF THE ABOVE ABANDONHOUSESEWER
IBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑SEEP.PIT(S) [J CESSPOOLS 0
OF PERMITTEE -'�?C TURE „' J, .` .:_ �- - --
TIF VALIDATION ROBERT A. WOOD
-. .::CK.. Ni.0, CASH SUPERVISING MEC•HANIGF.L,ENGINEER