HomeMy Public PortalAbout5004 WILLMONTE AVE_Sewer__ 3-64
76A642D APPLICATION FOR PERMIT
6A64 �
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY _-
NEAREST -
FOR APPLICANT TO FILL IN `ROSS ST. '. d`
LEGAL_ _—____.__- _._---f, ._._____._____.. _-- ��{J/ � r✓
DESCRIPTION LOT NO,, J�,r- ``
MAIL
BLOCK TRACT ADDRESS -_!—
NO. OF SLOGS. --'
SIZE OF LOT- 1' �_._NOW ON LOT `' dW�.'_..._ CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO, GROUP MAP PROCESSED BY
SK PG
CONTRACTOR �I / f• _�--'.-,9 '3 i:._-_. >� �.� :.. �i ,�j ,e1,4._.�L.'4,L.
ADDRESS 9 ,� CONNECTION DATR
CITY •� STATION ,1. ���y DEPTH / 1
STATE
REGISTRATION NO. ( ) COUNTY MANHOLE REFERENCE '3' Y /'i" 1y._ LOWER CESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM f
i! v
I HOUSE SEWER CONNECTING TO Y. CURB "t. M.L.TO P.L.
PUBLIC SEWER ¢6.00
P.C.NO,
SEPTIC TANK,SEEPAGE PIT OR - ,-
PITS AND/OR DRAINFIELD 510.00 CO,IMP.NO. G'r''"'Y JOB NO. 13b
HOUSE SEWER CONNECTING TO _ TRUNK PERMIT NO. ROAD PERMIT NO. 0
PRIVATE DISPOSAL SYSTEM 58.00
CONNECT ADDIT'ONAL BLDG,ORAFFIDAVIT WAIVRR IASIMINT RECORD. INSTR.NO. DATE
WORK TO HOUSE SEWER $3,00
OVERFLOW SEEPAGE PIT,DRAINFIELD ( W
EXTN.,CESSPOOL,DRYWELL..MANHOLE $9100 I _�(' HWY.OR ST.WIDENING
&ABANDON HOUSE SE [E!t:
W ER 0&9A L SYSTEM $3.00 STATE ENCROACHMENT
PERMIT NO.INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s 21 Oo --
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
C [? _---- -----
'i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWE - APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS -) DAY OF 19Q.-.'_' ------` -- -
OWNER OR �fJ� iGr`e NEW HOUSE SEWER
OWNERS AGENTf. - �,' ------ -
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS -
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT f HAVE READ 'THIS APPLICATION AND;OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY -----.------
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR -------
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM I }
CALIFORNIA OR THAT I AM THELEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER-
_ :i
SIGNATURE _ _ ❑
OF PERMITTEBACKFILL SEPTIC TANKS
E__
-''�'�..� SEEP,PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
(71/
M.O. CASH SUPERVISING MECHANICAL ENGINEER
.
Ila) j
-2
1-808 5
6A642D-65 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A.LANTHIE County Fnaincer ADDRESS 5
COLEMAN TV JENKINS, Supl'. ofliuil6ing
LOCAL;TY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
DESCRIPTION LOT NO. Owt
MAIL
_BLOCK TRACT ADDRESS
NO, OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO,
USE OF
BUILD I NGSDISTRICT NO. GROUP MAP PROCESSED BY
BK
CO
ADDRESS CONNECTION DATA
TtSTATION DEPTH
'- -1 6'4'
LICE NS LICENSE
N 2
CLASS x t-.MANHOLE REFERENCE `- "
7� LOWER
o.1 utscKu-riON OF WORK FEE TYPE OF CONNECTION LENGTH
___- - CONNECTING- -TO CURB
--L-SEPTIC
jFHOJLS.F SEWER3 Y. M.L.TO P.
,Ua iC SEWER $ 5.00
9EP f-1 C-TlK, —EFPAGEP1- OR P.C.No.
CA.
PITS AND/OR DRAINFIELO $10.00 CO.IMP,NO, JOB NO. 0
HOUSE E W ER-c-o�N—rEc i N-G—T 6------ TRUNK PERMIT NO,- ROAD PERMIT NO.
li PRIVATE DISPOSAL SYSTEM $ 3.00
WORK
ADDITIONAL SLOG. OR AFFIDAVIT I WAIVE RECORD. ATE
K TO HOOSE SEWER 3.00_j �oc,
ICE R 0,SPOSA, SYSTEM
SEWER
3.W HWY.OR ST.WIDENING Lu
j_EXTNCESSPGOL, MANHOLE $ 5.00
STATE ENCROACHMENT
PERCOLATION TEST r $ 5.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL CHARGES
OWNERS PERMIT 2: 00
CONNECTION CHARGE FEE
AUTHORIZATION[TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR CONNECT
ON N ECT THE: ABOVE DES ItRIB IED EXISTING DWELLING
0 THE P To E APPROVALS "IGNATURE
T PUBLIC SEW DATE INSPECTOR'
SIGNED THIS DAY-01
NEW HOUSE SEWER
OWNER OR
OWNERS AGENT
ENT CONNECI
f
BUILDING
JILDIN G , ,,)--
RK
ADDRESS
I HFRr8Y ACKNOWLEDGE THAT I HAVREAD THIS APPLICATION AND/DR DRAINFIELD
AND
D STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
SEPTIC'TANK,SEEP,PIT(S)
'- L)
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU MS!NG AND SEWERS, CESSPOOL El DRYWELL
I HEREBY CERTIFY T '- I_AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT;'I AM THE.-LEGAL OWNER OF,
�NDI INTEND TO
THE AS DESC "ED RE11DENTIAL ERTY. D G AND
ABANDON HOUSE SEWER
SIGNATURE
BACKFILL SEPTIC:TANKS
OF PERMITTEE SFEP,PIT(5) ❑ CESSPOOLS
RESIDE
I
VALIDATION-
CK. M.0. CASH
L[# o 2 4 Eat 0 24 -?TNAl I
E808 5 65
6A,342Z) APPLI TION FOR PER IT
COUNTY OF LOS ANGE S SE ER—SEWAG1SPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
L,
JOHN A.1AM1311, , County 1ginecr D
coiJAIAN 1�. JENKINS, Sup't. of Building
LOCA
- `Ross
FOR APPLICANT TO FILL IN _CRO55_ST.__
LOT NC .moOWNER
MAIL`-
BLOCK TRACT ADDRESS
NO. OF BLDG$.
E.
-L LEGAL
D K
ION
0
SIZE OF LOT NOW ON LOT 11111 TEL NO.
USE OF
BUILD..I- L_ CROUP PROCESS
.1
U DISTRICT NO. C MAP ED BY
FJkC G
To
CONTRACTO,*
ADDR
CONNECTION DATA
EL STATION DEPTH
Cill, -------
-
LICE N�� 1 C ENS E
NO.
CLAS
MANH
5 OLE REFERENCE LOWER
No.
DESCRIPTI N OF-WOFik FEE TYPE OF CONNECTION LENGTH F oll
SESEWER CONNECTING TO Y. CURB P.L. To Pt -i
LIC SEWER $ 5.00 _
P.C.NO.
T
S AND.OR DIRAINFIELD CO.IMP. N.- JOS NO.
$1 0.00 0
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. u
PRIVATE DISPOSAL SYSTEM $ 3.00
LCONNE ADDITIONAL BLD -}7R RECO—RD.FNS j7 W IN 0.1 DATE 0
99OW TO HOUSE SEWER $ 3-00
k--l—A Ly EV
SEWER'OR DISPOSAL SYSTEM
$ 3.00 Lu
HWY. OR ST.WIDENING CL
EXTN.,CESSPOOL. MANHOLE $ 5.0or
E Eb C &ACHMENT z
PERCOLATION TEsr $ 5.00i PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT sl _21 00
AUTHORIZATION CONNECTION CHARGE FEE
AL FEE 0
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN D CON- Rr'MSU_RSEM�I�IfE
T RACTOR TO CONNECT THE ABOVE DESCRIBED E ING DWELLING
To THE PUBLIC SEWER, APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS Y F9—
OR NEW HOUSE SEWER
OWNERS AGENT— CONNECT ADDITIONAL
ADDRESS - ""t'.=__BUILDING OR WORK
SEPTIC:TANK.SEEP.PIT(S)
—
OWNER
0
Ar
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELO
AND
STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING
MB
LU IN, AND SEWERS. CESSPOOL Cl ORYWELL ❑
I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED
L I CENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
rr
_A FORN A THE LEGAL OW 0
_ALI, I OR T14AT I AM 'T po F AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE All
.t� ,��SOVDESCRFr RESIDE IAL PR E TY ANDON HOUSE SEWER
StGNATUR E ;; I�/
,4e BACKFILL.SEPTIC TANKS
OF PERM ...... SEEP,PIT(5) ❑ CESSPOOL ❑
(IALIDATION
CK. M.O.
1