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Home My Public Portal About5216 WILLMONTE AVE_Sewer__ '6A -66 L•66�94.93 APPLICATION FOR PERMIT 1 S He DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. L.AMBIE, COUNTY ENGINEER ADDRESS �,? j{ 1- I,{;.,g„ %. =,. ,�✓°.�� CASSATT 0.GRIFFIN, SUPT of BullmlJG 'LOCALITY _d i12-i _ NEAREST FOR APPLICANT TO FILL IN _ _CROSS ST, ��.�,��':�✓ LEGAL DESCRIPTION. LOT NO. _OWNER a�'._ Ny,.T3 BLOCK TRACT ` 1r � MAILADDRESS NO. OF BLDGS, ' +� _SITE OF_LOT "J q'_ej.+NOW ON LOT �;� CITY TEL, NO. USE OF __-- BUILDINGS '�` :...— DISTRICT N0. GROUP I MAP BK PG CONTRACTOR ADDRESS CONNECTION DATA - --- DEPTH STATION yl MANHOLE REFERENCE r, UPPER CITY ❑ STATE -REGISTRATION NO , � '- t:.'•�- .,[�-CMNTYNO. DESCRIPTION OF WORK FEETYPE.OF CO_N��r_CTION LENGTH FROM ` HOUSE SEWER CONNECTING TO -- ---- f -�I - -W""� ">'I1T25.� R,.6.;-° M.L. TO P.L. PUBLIC SEWER__.. _ -- -- _- $3_50 ..� � — - ._ --- - 1TI SEPC TANK,SEEPAGE PIT OR _--- I PITS AND/OR DRAINFIELD. - OVERFLOW SEEPAGE PIT,DRAINFIELD I P,C. NO. �I FXTN.,CESSPOOL,DRYWELL MANHOLE CW $2.001. CO.IMP. NO_ r.34<.- JOB N0. - HOUSE SEWER CONNECTING TO 1 4 PRIVATE DISPOSAL SYSTEM pct $1:00 I TRUNK PERMIT N0, ROAD PERMIT NO.. --_- CONNECT ADDITIONAL BLDG.ORSTATESTATE ENCROACHMENT WORK-TO HOUSE SEWER (. $1.00 i ,PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE. -�---'--- --- ._ -------� -�- SEWER OR DISPOSAL.SYSTEM (n; INDUSTRIAL -_.. . . __. �. $t.00 � 'R'ASTE APPROVAL -I --------------------------. - �_--- _ CHARGES OWNERSPERMIT 1 00 -- -- --- -—----- ---- . _._ - -----------._. ---- REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE I � �7) APPROVALS 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- --,-APPROVALS SSIATURE t� T£ I N$P -^M TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _ I -f- TO THE PUBLIC SE:W'EP NEW HOUSE SEWER. SIGNED TH15DAY OF 19 _ -` r ,. ,. CONNECT ADDITIONAL —. OWNER OR J' BUILDING OR WORK — OWNERS A EN ,EPT L TANK,SEEP PITS) a .. �.. ! D/ AINFI ADDRESS ''�;— _ AN-.._OR DRELD __ ..-... I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL—11 DRYVdELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAVA'S REGULATING ,ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ,SND/OR DISCONNECT PLUG AND — — LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND WER CALIFORNIA. OR THAT I Am TYE LEGAL OWNER OF THE ABOVE --- - — — - ----- ..-------- --.— - DESCRIBED RESIDENTIAL PROT$RT EACKFILL SLEPTIC TANKS 1 - - P. PITS ) LI CESS POGO SIGNATURE : y',` w �....9"'r - OF PERM.IYTEIE„ v 4 .1 :. JOHN A. L,AM8 COUNTY ENGINEERVALID TIOI�i ROBERT A'WOOD, CHIEF PLBG. INSPECTOR S CK. N.O. CAbH - 76A642D 3-64 APPLICATION FOR PERMIT 76A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING f JOHN A. LAMBIE, County Engineer ADDRESS t ` WILLIAM A. JENSEN. Supt of Building --7�- LOCA1ITY NEAREST --I#�—��"..', r� / FOR APPLICANT TO FILL IN CROSS 57. _ 1 -y_ DESCR PTIONLOT NO. -�� OWNER TLE ALi MAIL BLOCK s I� BLOCK TRACT s + v f- ADDRESS _ -( ✓�sy NO. OF BLDGS. / y SIZE OF LOT NOW ON LOT CITY TEL. NO. C L- + [t D USE OF BUILDINGS DISTRICT NO. GROUP MAP PG PROCESSED BY Jt + j_ t7 CONTRACTOR Od/C '�a L�� ADDRESS t9..�1 ,�. �*:'L _ CONNECTION DATA CITY TEL. NO. v '`7 STATION DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION NO �a+- COUN7Y .EWER NO. DESCRIPTION OF WORK FEE _ TYPE OF CON-NECTION LENGTH FRGi4 HOUSE SEWER CONNECTING TO �i Y. CURS--__. PUBLIC SEWER Q $5.00 SEPTIC TANK,SEEPAGE PIT OR ,. NO. 0- JO PITS ANDOR DRAINFIELD 510.00 I CO. IMP. NO. .708 NO. IS. HOUSE SEWER CONNECTING TO ---�—�- TRUNK PERMIT NOS 4F20Ab-.p�ERM17 NO, PRIVATE DISPOSAL$YBTEM $3.00 1 - ! CONNECT ADDITIONAL BLDG.OR AFFIDAVIT .WAIVER EASEMENT RECORD.INSTP`NO. DATE WORK TO HOUSE SEWER 53.00 OVERFLOW SEEPAGE P17,DRAINFIELD �1-- ' �. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ S5.00 ALTER,REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING W SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT PERMIT NO _ E)' !� j'.'y; z ---- INDUSTRIAL WASTE APPROVAL CHARGES r OWNERS PERMIT $1 2 00 AUTHORIZATION TOTAL FEE 1 pr CONNECTION CHARGE FEE - — -iHAVE 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 DATE INSPECTOR'S SIG NATURE SIGNED THIS DAY OF 18^ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS_ BUILDING OR WORK - - - SEPTIC TANK,SEEP,PIT(B) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AICD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED A5 REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOV DESCRIBED REST NTI ROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE r .SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD � M,O. CASH SUPERVISING MECHANICAL ENGINEER CK. lac,3 3 2 3 0 F 3 2 8 D 5,00- %, ,,