HomeMy Public PortalAbout4937 WILLMONTE AVE_Sewer__ 3E.663 YY�SG D APPLICATI.ON FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAPABIE, COUNTY ENGINEER ADDRESS_ —
7 CASSATT D. GRIFFIN, SUPT of BUILDIND LOCALITY
_ FOR APPLICANT TO FILL IN NEAREST
ST.
__! -ROS
LEGAL
DESCRIPTION LOT NO. P�� � �4w J OWNER
MAIL
BLOCK TRACT
mayADDRESS
NO.OF
5 ms`s _Y `°�% NOW O BLOT S
SIZE OF LOT _.- C11TY" TEL. NO.,-
USE
O„USE OF Y
BUILD GS "�m,� 'i DISTRICT NO. GROUP 1 MAP
a-- ^_ PK PG
CONNECTION DATA
ADDRESS
- _ STATION &L' F DEPTH Y
CITY i TEL,.N0, ----- -- -
_� MANHOLE REFERENCE _eJPPEP=
- -STATE ------ ' -
,, - LOWER
REGISTRATION NO. ` ❑ COUNTY
NO. DESCRIPTION OF WORK FEE —` -- TYPE OF CONNECTION LENGTH FROM
FROM
HOUSE SEWER.CONNECTING T6— _-- 1 I --- Y CURB P.L.
PUBLIC SEWER _ _ C s 3.2U - ---- - - --...-
-`--� SEPTIC TANK,SEEPAGE PIT OR ---- ��--� t
PITS AND/OR DRAINFIELD $
iOVERFLOW SEEPAGE PIT,DRAINFIELD ' C. NO
EXTN.,CES POOL,DR WE'LL,MANHOLE (R' `$ ,001, I 'CO. IMP. N0. JOB N0,
HOUSE SEWER CONNECTING TO---� --- (-
I PRIVATE;DISPOSAL SYSTEM_ (711 $1.cQ _TRUtiKPERM IT NO. ROAD PERMIT NO, -
-- CONNECT ADDITIONAL BLDG OR - -- -`--:� STATE ENCROACHMENT-------' ------'--�.--`- - '-
WORK TO HOUSE SEWER ia, 'K 9.0^ I _ PERMIT N0.
-.-
--- -- --- - -- ---- -- - ----- -------
r
ALTER,-REPAIR AOR ABANDON HOUSE INDUSTRIAL -
—ji
SEWER OR D POSALSf .TEM WAST" APPROVAL— — — I — --
CHARGES
CONNECTION CHARGE FEE -- --� —
OWN R°S --PERMIT 1 ! 1.30
AUTHORIZATION TOTAL FEE-- --11 1 — REIMBURSEMENT FEE
I HAVE AT THIS JAiF P, COr1IR.ACT WITH THE HEREIN NAMED l.flN- APPROVALS DATE �INSPEC OR 5 'IGN TUP,E�
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I �
TO THE PUPLPI SEAT_R - - ,' NEW MOUSE SEWER
SIGNED THIS DAY OF r. _19 CONNECT ADDITIONAL I
OWNER OR BUILDING OR WORK _- - ----- I
O"'OVNFRS AG!:NT c SEPTIC TANK,SEEP,PIT(S1 _ -_- ---_-- -
ADDRESS 'L - '. :�_"�`�` FIFLD
AND/OR DRAIN _
+I
I HEREBY ACKNOWLEDGE THAT I 14AVF READ THIS APPLICATION CESSPOLL' DRYWELLD { I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _-. - --_. --4 --- -. ----
WITH ALL. COUN.Y ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/:OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
'CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBEDRESIDENTIALPROPERTY, BACKFILL SEPTIC TANKS
SEEP PIT{S? L! CESSPOOLS
SIGNATURE
OF PERMITTEE
T i
JOHN A.LAMBIE, COUNTY ENGINEER S?'FsLIDATI ROBERT A. WOOL). CHIEF PL,BG, INSPECTOR
CK, rtil. J .. A.�:r,11,1 ,q
3 E-669 iF.85 APPLICATION FOR PERMIT
i&E•66
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
Count of Los Angeles F3UILDING "� °
JOHN A. LAMBIE, COUNTY ENGINEER *DDRESS .d �$ '
J CASSATTD. GRIFFIN, SUP'rOFPUILDIniG
LOCALITY
_ FOR APPLICANT TO FILL IN NEAREST
Rassr
LEGAL �.
DESCRIPTION LOT NO. t1wNER „
---— - --
BLOCK TRACTMAIL` - _ _ w
ADDRESS14
,
�7
NO. OF BLDGS.
SIZE OF LUT NOW ON L07 N0.
USE OF — -- '� -
_LDINGS DISTRICT NO. GROUP MAP
BU
BK PG,
CONTRACTOR .,,. : ... .. w jM a
ADDRESS te....
1 CONNECTION DATA i
ar'�✓`>��Y. .d --- --
sa' STATION �'' _ D DEPTH '1
C1TY ? TEL. NO, — -"
- - _ � —� MANHOLE REFERENCE, I=
;IP
__ NO, O COUNTY
6. "STATE.
REGISTRATION ` T
N0, DESCRIPTION OF WORK� FEE —�- --
rHUU - -- - --- -_-�- �— "^ TYPE OF CONNECTION LENGTH FROM
..SELLER CONNECT NG TO--_-^ — I Y. CURB P.L M L, TO P L.
j PUBLIC SEWER $>,50 .--_ —.._._ —
i SEPTIC TANK SEEPAGE PIT OR -
- PFTS AND/OR DRA:INFIELD_ - rd $3.00 j f'"sit x A
OVERFLOW SEEPAGE PIT,DRAINFIELD 1 �- P C NO.
! LXT N.,CESSPOOL,DRYWELL,MANHOLE !d� $ 2.00 I I I.O. IMP. N0, JOB NO.,
PRIVATE DISPOSAL SYSTEM �tl $1.00 j TRUNK PERMIT NO. _ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR --_-- --- STATE ENCROACHMENT -
WORK TO HOUSE SEWER c'' $1.0 PERMIT NO. -
I
! ALTER,.REPAIR OR ABANDON HOUSE ! j INDUSTRIAL
SEWER OR DISPOSAL SYSTE6t __a, b 1—co WASTE APPROVAL
_--_ CHARGES
— I _ —_— --- -- =—
__.- CONNECTION CHARGE FEE
OWNER'SPERMIT I 1 00
-- --- REIMBURSEMENT FE
AUTHORIZATION TOTAL FEE - � -�- i �-C� -
I HAVE AT THIS DATE. A -CONTRACT WITH THE HEREIN NAMED CON- APPROVALSI DATE MINISPEC?DR"S SIC-NATURE
TRACTOR 1'0 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
1'0 '1HE PUBLIC SEWER. NEW HOUSE SEINER :i t
SIGNED TEI15AY 0 CNN CT ADDITIONAL
OWNER OR UILD NG OR WORK _
OWNERS AGENT._ .�
SEPTIC TANK.SEEP,PIT(S) I I
ADDRESS__, AND/OR DRA!NF FLD
I IIERCaY ACKN'JJLLDGETHAT I HAVE READ THIS APPLICATION :ESSPOOLO DRYVELL.❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY -----
IA1tTH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING ALTER,REPAIR,SELLER OR ' I
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT : AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG;AND ^�
LIC.ENSSE6 AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF j 1
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ASIDVE ABANDON HOUSE SEWER —_-_.--.—
D£SCR!BED RESIDENTIAL PROPERTY, i-ACh:Fi LL SEPTIC TAN: S_r; `
SIGNATURE SEEP PITS ;_,I CESSPOOLS___... . _._... -_. '---i----OF PERMiT'TEE
JOHN A. LAMBIE, COUNTY ENG!NEER .-VALIDATION ROBERT-A. WOOD, CHIEF PLCG. INSPECTOR
Clt, Id. O. GASH