HomeMy Public PortalAbout4938 WILLMONTE AVE_Sewer__ &7 E-6G3 5Y-�3� .APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDINGyJa _
ARUR
JOHN A. L.
AME31F, COUNTY ENGINEER --
uT CASSATT D. GRIFFIN, SUPT OF BUILDING - ---LOCALITY
_
FOR APPLICANT TO FILL INNEAREST -
R—S ST.
OS
LEGAL
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DESCRIPTION Lt NO, OWNER
�'` -�--- MAI L Y -
BOCK TRACT ------ -__-- ADDRESS --
o
NO.OF BLDG .
NOW ON LOT' -- ''
SIZE OF L07. - '' >, CITY TEL. NO. -
ffi. H
USE OF
BUILDINGS DISTRICT NO, GROUP MAP
1K PG
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CONTRACTOR s ;~
CONNECTION DATA
ADDRESS s �> _at"i
CITY NO. Ly •-^r _ ., S-iAT_ON Z� EPT I' ,-. - -.
-- f - ----- -- -- MANHOLE_REFERENCE y x dP l PPE -
REGISTR.ATICTN NO. r �,'�.. � COUNTY NO, ! L'ESCRIPTION OF WORK GEE TYPE OF CONNECTION '— LENGTH FROM fr—�
I�HOU�ESEWI:R CONNECTING TO @ JJO f i, y r TO P.L..—_�_----.--.
PUBLIC SEWER S_ __. --- - - - — --
-; SEPTIC TAIsK,-S EE PACE PIT
j
PITS AND/OR DRAINFiELD__ 91 $ ----_-
OYERF'LOIh SEEPAGE PIT GRAiNFHOLD ._ ' _ -) C. NU—_ -.
EXTN ,CESSPOOL,DRYWcLL,MANHOLE i«i S 2.001 ---' CO. IMP. NO. ,; ' IUB ti0. _
--� HOUSE SEWER CONNECTING TO---� --� ---- —
PRIVATE DISPOSAL SYSTEM C`i. '.0C ; j _ TRUNK PERMIT NO ROAD PERMIT
CONNECT ADLI :ONAi BLDG.OR ---- - ---
WORK TO HOUSE SEWER � I STgTE ENCROACHMENT
c1�FR �'7 PERMIT NO,
--.. ALTER,REPAIR OR ABANDON HOUSE -i EWER CP U!SrOSINDUSTRIAL __---__--_-.._.---_—_�- _--- --
:AL S t 1 E�.I «� L'C _ _-- WASTE APPROVAL
I ' CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT ---- '- -- —---
REIMBURSEMENT FEE
AUTHORIZATION -TOTAL FEE
APPROVALS DATE hNSPE'FUR'SSIGNA.TUR
( HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
NAMED CON- --_-- _----�___--
IRA TUR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING j
TO THE PUB111C SEWER, NEW HOUSE SEWER ! -
-�-
SIGNED 7i1i_____-DAY OF --ti9____ CONNECT ADDITIONAL
OWNER OR - BUILDING OR WORK
OWNERS "'" -'-"--- — --- SEPT'ICT'ANK,SEEP, PIT($)
ADDRESS AND/011 URAiNFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONi
AND -TATE THAT THE ABOVE IS CORRECT AND AGREE 'TO COMPLY iCESSPOUL[ DRYWEL_P,;
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WITH ALI. COUNTY ORDINANCES AND ST.A'IE LAWS REGULATING ALTER,REPAIR,SEWER OR �
PLUMBING AND SEWERS. SEWAGEDISPOSAL SYSTEM I
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND'OR
LfCENSED AS RFQUiRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i AM THE .LEGAL. OWNER OF THE ABOVE ABANDON HOUSE SEWE:F f
DESCRIBED RESIDE TIAL PROPERTY- „- BACKFILLSEPTIC'TANKS j
SEEP.PIT(n) ❑ CESSPOOLS 0
SIGNATURE � i
OF PER1alTTEE” �- e ------- --I
OHN A. L. E, COUNTY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PLEIG. INSPECTOR
__- N. C. CASH -
,! 1 f5
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