HomeMy Public PortalAbout5022 WILLMONTE AVE_Sewer__ IOA64 I.��basa APPLICATION FOR PERMIT
r�As�
COUNTY OF Las ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION sulLDING
JOHN A. LAMBI£, County Engineer ADDRESS
5
�SYILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN RCSB 5T
.LEtxA!
.y
i
DESCIi t TION iJT NC J •'"ti �',.^y 'y �: OWNER
- f MAIL
BL Chc K _TRACT ,y ADDRESS
LD6S,
SIZE OF LOT .. ,Z LL.T CITY TEL. NO.
USF Or
FiU�LD!NC�S sk DISTRICT NO. GROUP MAP FR OCESSED BY
-✓y�[`gJ' 'may BK PG
CONTRACTOR
ADDRESS
f. J r+a TION DATA 4,
,C STATION �+' - ' DEPTH �.
CITY f' - '".n._.^.f Ei, NC.a-.._� ''�
�-' r T TE MANHOLE REFERENCE ff p' ,�
REGISTRATION N S
.__ -� S0 TE LOWER
NO. t- ESCFi1P'FIdN 1= d K FEE ..-_TYPr7.OF CGONNEI 7'!ON _. LENGTA FROM/
14lU SE SFWE?CONNEcrING TO �! -- Y. CS -dP P L M.I..TO F.L.
P1&LI SEWER C �s;Do Y ----__ -- ,F4 y¢--- ---- ----- -------.
j
EPTIC TANK,5EEFAGE PIT OR
Co. !MP.NO. �' , a�"!� JOB NC,
PITS AND/OR IIRAI:V FIELD Q $70:00 -__--__..__._-� s-�-.�- �___- _.__._.___.___.-_-_-_.____-_ __._. �✓
__-_.__<____-_. //qq
f P IV SL ISP CON SYST�'m TO TRUNK PERMIT NO. ROAD PERMIT NCS. 0
�
PRIVATE 4T D 5 O AL 5Yb7EM Lh $�00 [-.
! C'NN L'U 7'4'N 4L PLJC PR _. -_...A I A . -RE-COW.,_
i AF F?DV T We111 ER EASEM4 yr 1 INSTRI NO, PAYE
WORK CO HOUSE SEWER $3.00
—_
OVERFL-OW SEEPAGE PIT,ORAINFIELD
FXPN CESSPOO1,D?{YV1+LL h ANHOLE @ $5'00 !—.. � ._— _HWY.OR ST.WIDENING
- .—--
_
i ALTER:,REPAIR DR ABANDON H011SE '.
SE:WER.OR DISPOSAL SYSTEM @--33,00 ! STATE ENCSiOAC HM EN7
! PERMIT NO.,
INDUSTRIAL
WASTE.APPROVAL
CHARGES
OWNER'S I7ERMIT zi Do ---- --- - ------ --- —. _—._
--- ---
.. CON N.EC71ON CHARGE FEEAUTHORIZATIAUTHORIZATION TOTAL FEE ® __---- - — --- -------- ----- -- - --
1 HAVE AT THIS DATE' A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �___.
TO THE PUBLIC SEWER. APPROVALS RATE: �INSPECTOR'S SIGNATURE
SIGNED THIS__.—DAY dF -----_. 19'.— ----- -------------------------
OWNER
- •---OWNER OR NEW HOUSE SEWER j
OWNERS AGENT---—-..
CONNECT ADDITIONAL
HU ILDING OR WORK
1 HEREBY A LF
KNQVVC THAT I HAVE RFAD THI$ APPLIC'A11CIN
SEPTIAND STATE THAT 'THE ABOVE I S CORRECT AND AGREE TO COMPLY ._ r A.NK
—SS.�Ed PI�I—F�)--EL,DSS.�Ed PI�I—F�)
_,
WITH ALL-, COUNTY ORDiNAN!_ES AND STATE LAWREGULATING � C
CESSPOOL DRY L
PLUMBING !
AND SEWt RS. G a' L_
LIjHERESY CERTIFY FPiA.7 I AK PROPERLY REGISTERED AND"OR ALTER,REPAIR,SEIYER OR
::ENSE'D AS REQUIRED 8:Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPC•SA.L SYSTEM
CALIFORNIA OR THAT I AM! THE LEGAL OWNER OF, AND INTEND TO _—NNECT PLU AND
R.E.SIDE IN, THE ABOVE DESCRIBED RESiDEN TIAL Yf;Oi E'R71'. DISCOj
ABANDON HOUSE SEWER
SIGNATURE
Or PERMITTE ' BACKFILL SEPTIC;TANKS
SEEP.PIT(S) 0 cEsspooLs
i
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
M.O. CASH