HomeMy Public PortalAbout5033 WILLMONTE AVE_Sewer__ 24650 INSERTS
CES08 C-00
7tAti42D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
FOHN A. LAMBIE. County Engineer py
WILLIAM A. JENSEN, Sup"t of Building LOCALITY l
FOR ,APPLICANT TO FILL IN
NEAREST
CROSS ST. -
LEGAL rg `
DESCRIPTION LOT NO. 4-c.�'� OWNER
BLOCK TRACT 'T44s, MDDRAIL
AESS
NO,OF BLDGS. t '�
SIZE OF LOT NOW ON.LOT f CITY' TEL, N0,USE OF
' _
BUILDINGS Y - DISTRICT NO. GROUP S -MAP PG PkOCESSED BY
CONTRACTOR w 47
' r j` )c ..
ADDRESS11
, „- C CONNECTION DATA /
CITY r'9 ,J TEL.NO. _ .r STATION .; ,. DEPTH
r,/ � "y STATE MANHOLE REFERENCE -
REGISTRATION NO.N-5 7tj ,d 4- Y ✓,: J OWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO 'r
PUBLIC SEWER @ $9.00 0 TYPE OF CONNECTION LENGTH FR01,1
SEPTIC TANK, SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. -
PiTSANuIORDRAINFIELD L? $3.00
OVERFLOW SEEPAGE PIT, DRIE
AINFLD
EX1';t..CES ;OOL DRYWE6.L @ $2,00P,C.N0.
HOUSE SEWER CONNECTING TO
i PRIVATE DISPOSAL SYSTEM @ $1.00 CO,IMP.N0. )'` .703 NO.
S+
CONNECT ADDMONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0. O
WORK TO HOUSE SEWER @ $f,00 _ C
A'T'FR. R.E'PAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER-OR DISPOSAL.SYSTEM @ $1.00 O�
PERMIT N0. - W
INDUSTRIAL
WASTE APPROVAL W
CHARGES
�a*
OWNER'S PERMIT `$ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE_ t7 REIMBURSEMENT FEE
I HAVE AT THIS DATE A. CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR 'TO CONNECT 'THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. -
SIGNED THIS 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL.
OWNERS AGENT I z BUILDING,OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
-
— AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL (]
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMB[NG AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I PROPERLY GI E. D AND/OR DISCONNECT PLUG AND
LICENSED REQUIRED L A CELE CO TY STATE OF ABANDON HOUSE SEWER
CALIFO A THAT A HE L OW ER TH ' ABOVE BACKFILL SEPTIC TANKS ❑
DE:SCR[ ED RESiD Tl PR RT SEEP, PIT(S) ❑ CESSPOOLS Cl
SIGNATU
OF PERMI
�r I—VALIDATION ROBERT A. WOOD
CK. X.o. CASH SUPERVISING MECHANICAL ENGINES.R