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HomeMy Public PortalAbout4932 WILLMONTE AVE_Sewer__ c>_sos 11-57 APPLICATION COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS CASSATT D. GRIFFIN, Supt of Building LOCALITY ___. — FOR APPLICANT TO FILL IN —CROSS ST. J--- LEGAL — -- DESCRIPTION LOT NO. OWNER LOCK TRACT +� MAIL. ADDRESS,_ N0.OF SLOGS. SIZE OF LOt — _..-- --.— � � -NOW ON LOT ? CITY .M.N0. USE OF 4./ BUILDINGS.... .+ DISTRICT NO. GROUP MAP CONTRACTOR _ r q _ atK PG P ADDRESS CONNECTION DATA - ,._,..._: u . !—A CITY TELNO. STAT ION '° � .� DEPTH . e — REGISTRATION NO. COUNTY ATE MANHOLE REFERENCE e PPER,`; -* r LOWER DESCRIPTtiON 6 w°aRK^ FEF , HOUSE SEWER CONNECTING TO PUBLIC SEWER — SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECT1CNy 15 LENGTH FROM PITS AND/OR DRAINFIEI.D Lm $3,06 — Y. CURB—�,¢I' M.L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIE:LD EXTN.,CESSPOOL,DRYWELL,MANHOLE (g $2:06 HOUSE SEWER CONNECTING TO CO,IMPP.C.NO. PRIVATE DISPOSAL SYSTEM (g? $1.00 .N0, .{'A ; .106 N0� CONNECT ADDITIONAL BLDG.OR - -'---3"—� 7 --- WORK TO HOUSE SEWER _ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO, ALTER,REPAIR OR ABANDON HOUSE .� SEWER OR DISPOSAL SYSTEM @ $1,00 STATE ENCROACHMENT -- PERMIT NO. INDUSTRIAL i 'r{ASTE APPROVAL CHARGES OWNER'S PERMIT $ _Q© CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE �I REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ' DATE INSPEGTOR'S_1G'�ATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF---I 9__ NEW HOUSE SEWER b OWNER OR CONNECT ADDITIGNAL OWNERS AGE4dT BUILDING OR WORK ADDRESS__ SEPT!C TANK,SEEP,PIT(5) --- — .---__ _AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ 'CHIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE 'TO COMPLY _ CESSPOOL[]_D_RYWELL[] WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -- PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM _ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT IAM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSESEWER_ DESCRIBED R:ESIDENTIA'_ PR('?E;RTY. BACKFILL SEPTIC TANKS ❑ I SIGNATURE SEEP. PIT(S) C1 CESSPOOLS 0 _I OF PERMITTEF (� VALIDATION ROBERT A. WOOD chSR SUPERVISING MECHANICAL E;NGINEEFi