HomeMy Public PortalAbout5026 WILLMONTE AVE_Sewer__ C 808
78A642p APPLICATION FOR PERMIT
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COUNTY TMENT C
OF OS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
TOEIN A, LAMBIE, County Engineer ADDRESS
W LLIAM A. IENSEN, Supt of BuildingNEAREST-
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FOR APPLICANT TO FILL IN cROSS ST. Y
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AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I. HAVE AT THIS DATE. ±A. CONTRACT WITH THE HEREIN NAMED CON- RElMB RS EMENT FEE
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To t.Oaf EC"i 'TWE ABOVE ^ _ APPR®YAdea7
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OWNER OR NEW HOUSE SEWER. '
OWNERS ADEN
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BUILDING OR WORK
ADDRESS _._ -
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AND STATE' THAT HE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAfNP_ELD
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iFBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
VlhlHLi- CO NTY ORDINANCES AND .STATE LAWS REGULATING
PLUM B i Nfi ANG, SEWERS. CESSPOOL iJ DRYWELL- []
I HERESY CFR =Y THAT ' AM PROPERLY REGISTERED AND/OR ALTER,REPAtR,SEWER
OR
AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL STEM
CALIFORNIA CI THAT' I AM THE LEGAL OWNER OF, AND INTEND TO ._--`._—
D lSCONNECT PLL V AND
RES"'-" IN, THE ABOVE' DESCRIBED RLSTOFNTIAL PROPERTY. ABANDON HUUS_ EY R- I
sIGF PURE, HAC'FCF'ILL SEPT3L APs'Ki ❑ � _-.._-_._. -- __..__.___.
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OF FEFi MfTTEE, �_ ` +.J_. _ .FDEEP,PIT(S) ❑ CESSPOOLS ❑.�
VALIDATION ROBERT A. WOOD
erc. M.d. GASH
SUPERVISING MECHANICAL ENGINEER
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76A64 "' 6' APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISP6SAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �`� ,�•� � �;
JOHN A. LAMBIE, county Engineer
ADDRESS
WILLIAM A. JENSEN. Supt of BuildingI
OC
ALITY III
NFA RFS FOR APPLICANT TO LL IN RO55 ST/._
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1^t0 {-""Ly' i, _ '� OWNER
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RAT)OATE MANHOLE REFF'RENTER G' � COUNTY "
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LOWER
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No. DESCRIPTION OF WORK EEE �
__ y'E OF r�a£ TIVN Lh FROM.� FROM. y_-
I HO J9 . 4V R ONNE,.7ING To -..— _.--_ .. Y,y�.s ac Z �'G R,�"". P M L TO P.L.
—_ PITS AND/OR GRAINFIELDEAT OR—..__� � P C.NO.
1TANK,
SEEPAGE
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TRUNK.'.ftM'T NO. ROAD PERMIT
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AFFIOAVI, wn;�ex EAS`xEkF� 2ECORD.7NS7R.NO, I � DATE
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RK.TO HOU S£•WCP @ 53.00 I 4
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OVERFLOW SEEPAGE
F.PIT,GRAIN FI E!_E? �i � _ '
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EP..R PA1-R bR AEA t-.DON}IOU SE. HWY.OR ST.WIDENING
i.SEVr'EH OR DtS€sOSAa_SYSTEM @ $3.00 STATE ENCROACHMENT
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I PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER S PERMIT � — of on — CHARGE
— - ti
-- — — -- +
CONP�l EC TION C`1A RGF F€:F 7''"
AUTHORIZATION TOTt�L ' �' - -
I HAVE AT THIS DATE ACONTRACT WITH THs_' HEREIN NAMED CON- REIMBl7 RS_ME_NT FEETRAf 0V To
t O'+INEC'I: YHE A.90VE DESCRIBED EXISTING DMV FEEING ryy
7'O 1VIE PUBLIC SEWER. APPROVALS I DATE �INSPECTORS SIGNATURE
SIGNED THIS---.---DAY 0P__...-_—___—.__--19_._
OWNER OR NEW HOUSE SEWER
OWNERS AGFNT.—___..--__.__
-----------'----' -- CONNECTADDITIONAL.ADDRESS I I
BO ILDI NG OR WORK
--
SEPTIC TANK,uEEP,.PI'T(S) iT
I HE EDY At KNOWLEOGE THA HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND 5YATE THAT THE ABOVE IS. CORRE',CT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING:
IL
U h98iNG AND :LWE'.fiS. CESSPOOL [7 DRYWELL
1 n`[RE9Y CERTIFY YHA'i' 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.'EWER OR V
LICENSED A5 REQU[RE;D BY LOS ANGLES COUNTY AND 5T'ATE; OF SEWAGE DISPOSAL SYSTEM I.
C_ALIFORRIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO --__--- - - ""'- --�'"�--'—'�-"-------""—'
RESIDE IN, THE ABOVE DESCRI13ED R"tOENTIAL. PROPERTY,_ - DISCONNECT LL AND I.
^Y ABANDON OU. E SEWER f
SiGNATURE
MI7TEF_._...__ 1.., + �. BACKFILL SEPTIC TANKS
OF PERrj
- �_.�.- PITSl [] Cr..SPOf')t.S
VALIDATION ROBERT A. WOOD
CASH
CK:1 M.
SUPERVISING MECHANICAL ENGINEER
6.