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HomeMy Public PortalAbout5030 WILLMONTE AVE_Sewer__ �r ane r -ss y : APPLICATION FOR PERMlY COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADORES JOIN A. LABIr, County Engineer WILLIAM Aa J£IvSE1V, gsup'f of Building LOCALITY r✓ L NEAREST FOR APPLICANT TO CROSS S �2� - - FALL IN _ DE.SCR TIC:N LOT NO. „ �w`:"� ✓y` .`�C.. OWNESt MAIL E3L0Cfi TRACT A D DRESS 1 .ti OF LOTr` '`---"y --�—�'''dl'sN'' '� �T CITY TEL. rd 0. h3U ILD:TiGS DISTRICT NO. GROUP MAP4;PttO s6E BY SK ON TRATOR ADDRESS _.. j _COIF NECTION DATA DEPTH 5'+YA E L.- g y� COU NYY MANHOLE REFEftENCF. + CL RELi FSI KATION NU NO DE.Sc RIPI IO?t! OF WORK -_- FELE 7Y OF GO h'1FiECT1 '�a LENSTH f'RCAt �— HOUSE SEVL cR CONNECTING 70 Y .� IS .. M.'.. Acs J'+.L. / PUBLIC SCVJEFt- ___ __. _ .- P C:.NO $3,DO SEPT I..TANK 5"E AGE:PI'T OR CO.IMP NO.a+ JOB NO Pt ND ORDstAINFI Ec D � $x{].00' I 'i d.._� HOUSE SN R CNNFCTINC TO TRUNK PERMIT€O ROAD PERMIT NCX- %' � U PN ATEC_POS:AL,SYS1 em @ $3.Ob pyy. _ — —. - T _— — —______ — — CONNECT ADO[Ti ONAL NLDC OR AFFIDAVIT WArVtR EAS:€MFI'y � R=CORD.iNSTR NC I DATE ! WORK TO HOUSE SE (41WER @ $3.00 f UL LP2clOVV ScE PA GE.PiT.DRAINf"iEL.D FXT .,CE�fi POOL.DRlWELL,MANHOLE CO $5.00 —__ HWV.OR ST.WIDENING ALTER,REPAIR OR ABANDON HOUSE &EWER O DISPOSAL SYSTEM - - STA7"r.ENC ROP.Gt1MENT PERMIT NO. INDUSTRIAL WAS,,.£APPROVAL L .. O R` IaFRI�IIT $ 2�raoAl gg gy�ry 7p y r --- --- ALTTI�(t3IATI®N 'TO'TAL F'E�'',- e� CONNECTION CHARGE SEE HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACY R 7i1 COY hF'E:T 7+iE AL30YE i7ESCRieED EX I.c.T'INO DWELLING APPROVALS TO THE .'-.'HLf C. SEWER. .DATE INSr ECT4]R 55i0NA7U RE a!GNF_L THIS—__DAY DF._ »t9.—. OWNER OR NEW HOUSE SEWER OWNERS AUE'NT______ CONNECT ADDIT ZONAL I j BJIL.DING OH WORK I { __ ADDRESS_______ ____._ __ --_.. .,___.L., _-_____.__ _ SEPTIC TANK.SEEPi,iS) i �.. I I1i ' 713Y ACK4 OWLEDGR THA I HAVE' BEAU THISAPPIJ CA'T ION � AND STA 'THAT T=IE AHOVE 15 CORRECT AND AC,it�E 70 COMPLY AN7l OH DfiAll`7 F'Ik LD WITHALL COUNTY ORDINANCES AND STATE. '._.AWS REGULATING ? PLUMBING AND SEWERS CESSPOOL. i`_l DRYWELL _—__- _R__ HEGF'.RY CERTIFY T'H-A'i AM PROPERLY REGISTERED AND'OR ALTER, R­____ F_PAI R.S YVcR OR � I L-f_ENSEO AS REOWRE,(7 BY IL0 ANGLES COUNT`( AND STATE OF 5E1A'A GE 615PCJ SAL SYSTEM CAL-4-ORiJ7A OR TtiA7 I AM THt' LEGAL OWNER OF, AND INTEND TO PI— F.ESIDE, fl THE ABOVE DESCRIBED? RESIDENTIAL PRQPF RT'— ABANDON HTOU SF SG AND1YJ EER SIGNATURE OF PERMITTEE." �f � iii -=_ �" �!' - '..Y r BACK11LL.SEFTiI TANK' _{ —L� SEEP.PIY(S1 U _ESSPOO[ VALIDATION ROSE T A. WOOD 0KM.U. CAS SUPERVISING MECHANICAL ENGINEER '". "�;'' CE806 !0.62. 7$A642E4 APPLICATION FOR PERMIT" COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL_ DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ULDINcBD _ r JOHN A LRR83E. County Engineer Ass WILLIAM A. JENSEN, Sup'i of Funding � ✓',� F : - L DC OCALITY .NEAREST FOR APPLICANT TC FILL AN R°`5 T DE'S"!"PIPE Oh3 LOT NO '�-"s�_ "' ,��,._,'�✓' OWNER MAIL BLOCK TRACT .ADDRESS ' • S ZE OF LOT - hQ C ITY TEL. NO. LISE OF- ---a- BUILDINGS DlSTRICTht0. GROUP- MAP ;P,riO✓`I SSl '�iBY. 5K PG CONTRACTOR y - -- -' ADDRESS f) $) s CONNECTION DATA iV > 5 AI 10N DEPT H CITY y -•r ..Y ,tom L STATE MANHOLE REFERENCE �. UPPER REG! T2ATIGN nO �� J ./- EJ COUNTY -- )JO LIE jCRtC'�`I_©M YVGh'h TYPE OF'COa CT•S�' !� Y_-�- LENGTH F'RbA I HOUSE SEWER CONNECTING TO _ Y. TO `-._ '47t E "`_ f �, y M.L TO h"_L_._'._._ _.____ $S,OQ _ - �_- P.C.NO. r I SEPTIC TANK.^EEPA GE PIT OR . _ PITS,4NO >R.,RAltJ rl.=,LD � $tQ,OQ i:0IMP NO. � �" SOB NO. _ ` IOU . SEWER CONNECTING T4 TRUNK PERMIT NO. ROAD PERMIT N6 O F R .VA,E DISPOSAL SYSTEM' . -_ $3.00 _- , CONNECT ADDITIONAL BLD< OR-ORARECDRJ.INS—rIDAV1T WAIVER ASc"tiT N - - (.•� DATE LUW RK TO HOUSE SEWER G� ss'00 ! i i LU - DFAi 7J R L.O , SE L, L PIT.L.MANF Ei,.D 4i eY_ OR ST.bYIDENL-_. KCN C.E SP OL,DRd HELL M NifOLE� $5,00 v IN i 11 A T A P ROK FE"ANDO'J HOUSE -� - SEWER OR DISPOSAL �,:.T M $3.OQ __ _.__. _ __._ _.. __ .__._ ..y. STA ENCROACHMENT.. t - IF MIT NOINDUSTRIAL . �. WASTE APPROVAL O /•p� VV N11w.s k�EkIMIT $ i�ec• _. __ CHARGES O7dNEC TION CHARGE PEE 1 AUTHORIZATION 1?I�ATICN TOTAL FEE '" a ,_ -- - :°- -k�-'� ,2— f I HAVF. AT T'li1S DATE A. CONTRACTWITH THE HEREIN�ED' CON. REIMBURSEMENT PEE TRAC TGT. '70 ONNECT THE ABOVE DESCRIBED EXISTING DWELLING ------- ---- -------I DATE-- !NSPECrOR'S SIGNATURE THE PUBLIC SEWER- APPDDqf1L— SIGNED OWNER 7.2 NEW HOUSE SEWER D\`d^J '.RS AGE:'•IT__.___._ _�..___—__._— ____—__._____ CONNECt ADDITIONAL — BU! ,DING OF WORK StfTIC TA t K cFLI P'T(5 I HPR BY ACKNOWLEDGE THAT { HAVE READ THIS APPLICATION NDi O. ORA-NF1 D I 1 AICD.SCATS' THAT THE ABOVE. iS CORRECT AND AGREE TO COMPLY LEITH ALL COUNTY ORDINANCES AND NATE LAWS REGULATING PLUMSING AND SEWERS. CESSPOOL [JI DRYWELL 1 HEREBY CERTIFY THAT AM PROPERLV FJEGI5TF:RED AND/OR ALTER,REPAIR,SEWER OR i LIC:.EN,.ED AS RFQ`;IREq BY •1.05 ANGLFS COUNTY AND STATE OC SEWAGE DISPOSAL SYSTEM. t'nt.; t P1I R. OR TH A'F 1 AA. THE LEGAL OtiHNER Or AND INTEND TO DISCO NNECT 'a'LUC AND ---- RESIDE I J, THF ABOVE DESCRIBED R�,SIDCNT AL F`ROP TY ABANDON H(JUS[.SEW F•R j 5 GNAT PERM OF' URE 4{ BAGFIL1 SEPTIC TANKS SEEP.PITYS' l7 CESSPOOLS �� ALMATICN ROBERT A. V+lOOD SUPERVISING MECHANICAL ENGINEER F CK. CASH 8914-14), AUG 14 1 1 D 2 5.0 0 14