HomeMy Public PortalAbout9144 WEDGEWOOD ST_Sewer__ DEPART OF COUNTY. SEW
ER=SEi6�AG.E' DISPOSALDIVISION OF BUILDING AND SAFETY PERMIT APPLICATION s
COUNTY OF LOS ANGft"S
'BUILDING _
WILLIAM J. FOX} COUNTY ENGINEER ADDRESS
_ADDRESS rtd� v, �4
FOR APPLICANT 'T FILL, IN LOCALITY
BUILDING �f� a NEAREST
ADDRESS '/'__"�I� a✓t��'-.�A�G+ ✓ s'`irr"+�I . CROSS BT. -
... � DISTRICT NO. SERIAL N0: PERMIT N0:
LOCAL•LTY - -
NEAREST' _ -� A // [� S
CROSS ST:
ErRSC IYED Ready for inspectionotioa DATEISSUED
OWNER C
MAIL �
CITY TEL.NO.
CONTRACTOR ./// / 'eo1l�'GP.tiAlcs� 9s•Py:rlG�+: �--- - ---'+
CO.IMP.N0:
ADDRESS � ��y JOB:N.D.
CITY .'�. 'TEL.NO �f�SS04 'TRUNKPERMIT NO.
REGISTRATION N0. TATE - —•
a� g� - COUNTY. ROAD PERMIT NO.
DESCRIPTION LO.TN.C. I/VI"!/ Lot 0 ST.ATE'ENCROACHMENT "
PERMIT NO.
BLOCK TRACT WASTE AP ROVAL
SIZE'OF LOT $ N0.OF.BLDGS.
NOW ON LOT CHARGES
E.Op
BUILDINGS.. / f/��pjy�f�J.`. CONNECTION:CHAP.G F.EE
US
NO. DESCRIPTION OF WORK FEE REIMBURSENIENTFEE
�
HOUSE SEWER.CONNECTING TO
PUBLICSEWER ER $ 3.50 RECEIPT NO. I DATE fI f joy
H.OUSE8EWERCONNECTINGTO
PRIVATE DISPOSAL SYSTEM ' I:00
CONNECT ADDITIONAL.BLDG.Olt EXCEPTION BE6 R.DED
WORK TWHOUSE SEWEFF 1.00 NO.. D TE Z BY
ALTER.O.'R REPAIR EXISTING . /
SEWER OR DISPOSAL SYSTEM' _ LOD
DISCONNECT AND ABANDON SEWER
AND/oR:DlsPasAL;SYSTEM a:oo . CONNECTION. DATA
SEPTIC-TANK;SEEPAGE.PIT OR
PITS AND/OR DRAINFFELD STATION d 1 DEPTH:
CESSPODL=DRYWEL'L -
SPECIAL CONDITIONS ONLY - 2.00. fJ IA. / MACMEFERENC.E
4"PE OF CONNECT]O 'LENGTH FROM
uyn (�P L M L.TO P L.
OWNERS PERMIT ; .. 1 00:
AUTHORIZATION TOTAL.FEE leo Iga
I.HAVE THIS DATE CONTRACTED WITH-THE HEREIN.NAMED-
CONTRACTOR TO..CONNEC.T THE ABOVE DESCRIBED EXISTING APPROVALS INSP.ECTOWSSIGN:ATURE DATE
DWELLING TO THE PUBLIC SEWER.
' ' NEW HOUSE SEWER
SIGNED THIS__._. .: AY.OF' -_.. _��.19��._: : f3 "c
OWNER OR q + / BU CONNECT
ADDITIONAL WRK
OWNERS AGENT.-A
- -- - s.��L:._" •':_.. .......
_ .8 PTIC'TANK,SEEP..PIT(S)
-- ----._ •...._`® ..._.....__. AND/ORDRAI.'NFIELD.
- '
I HEREBY ACKNOWLEDGE,THAT. i HAVE READ THIS APPLI CESSPOOL:3 .DRYWELL
CATION AND STATE:THAT.THE ABOVE 18'CORRECT AND AGREE;
TO COMPLY.WITH ALL COUNTY ORDINANCES..AND'STATE LAWS. ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE"DISPOSAL.SYSTEM,
1 HEREBY CERTIFY THAT 1 AN PROPERLY :REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED.BY LOS ANGELES COUTY ABANDON HO,PLUGAND
AND STATE OF CALIFORNIA OR THAT.1 AM THE LEGAL 49,N-
ER OF THE ABOVE DESCRIBED RESIDENTIAL. PROeP�ERTY.* 'BACKFILL SEPTIC—TANKS
SIGNATURE y ;�� SEEP:PIT($)� :CESSPOOLS .
OF PERMITTEE...__®� ''
70.642D 003' 1 J59 '` `. f^• y y .