HomeMy Public PortalAbout4947 WILLMONTE AVE_Sewer__ IlDEPARTM(ENT OF COUNKY ENGINEER SEWER®SEWAGE DUSPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNW OF LOS ANGELES BUILDING il /
WILLIAM J. FOX, COUNTY ENGINEER , ADDRESS 4— � �� 'L��Jr r/ l
FOR APPLICANT TO FILL IN LOCALITY �r � •�, +� ;'_-'%;�-+-r
BUILDING / //�/� +�' / ,/''`�/ �"� NEAREST [� u
ADDRESS �!"'7 - -7 ll 91.�SiLX•}3tIYT.'r �1 s{ CROSS ST.
LOCALITY J DISTRICT NO. SERIAL NO. !' ,PERMIT NO.
' NEAREST
CROSS ST. / .e REC'EIV.ED�Y Ready for Inspection DATE ISSUED
OWNER lih - :/lw : 'C ► ���J s f'ol
MAIL, I��� ( 1 4 USE ZONE OCCUPANCY. BK-
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ADDRESS '�-�� `T 4(
CITY��'sn�� _�_, .esu TEL�I Dr�'•�- I
CONTRACTOR i �i t ,),t7j CO.IMP.N0.
ADDREB �. a 'r ter, w �I JOB NO.
ejr` 6'.i
CITY /oy.112114 1� FEL.N TRUNK PERMIT NO.
` f � 7 � ® STATE , : t_
REGISTRATION N0. f t :4r COUNTY ROAD PERMIT NO.
r.
LEGAL f/f„,/` � ./ yr, STATE ENCROACHMENT --�
DESCRIPTION L T N0. 7 � yx, �z PERMIT NO.
BLOCK TRACT 7T 3 5? INDUSWASTAPPROVAL
SIZE OF LOT90.OF BLOSS.
NOW ON LOT CHARGES
USE OF
-BUILDINGS CONNECTION CHARGE FE
,,����'{' "0 vt�"
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER S 5.50 RECEIPT 110. I ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 .
CONNECT ADDITIONAL BLDG.OR EXC ION ECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING_ No. I DA E I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/O.R DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH ;
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 D 1/► MANHOLE REFERENCE
pOLOWER
PEO/FICONNECTION LENGTH FROM / 6"
OWNERS PERMIT ; 1 00 -r.-= Gu6: P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE t 7 e
I .HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER ,,✓• '�2��y�!
SIGNED THIS_ .,DAY OF...._. .. ....19
-�(I, CONNECT ADDITIONAL
OWNER OR i + BUILDING OR WORK
OWNERS AGENT..:�_..�,�:�_����•••"�����._. .�G: �
yt;/ ``�� ���yy � SEPTIC TANK,SEEP.PIT(S)
ADDRESS...7.,... ..l.:j6..�[_:_ AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL 0
CATION AND STATE THAT THE ABOVE IS.CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM. PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES, COUNTY ABANDON HOUSE SEWER •s "
AND STATE OF CALIFORNIA OR THAT 1 AM-THE LEGAL OVp.
ER OF THE ABOVE DESCRIBED RESIYXNTfAL PROPE BACKFILL SEPTIC TANKS�i ,I
A 'r SEEP.PIT(S) CESSPOOLS 41, ".
SIGNATURE14
OF PERMITTEE..__ _.?,�L.._.1 .�stf
70A042A 663 7/5S