HomeMy Public PortalAbout9163 WEDGEWOOD ST_Sewer__ 2i70
6.A 6 APPLICATION FOR PERMIT
' 642G
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEARFST-
FOR
NG
JOHN A. LAMBIE, COUNTY ENGINEER S
COLEMAN W. JENKINS, SUPT. OF BUILDING
TY M Y
APPLICANT TO FILL IN S7(PPISIT OR. TYPE. ONLY) �� ��., -
_LEGAL _.__
JJ I. .. C .
DESCRIPTION OWNER _
MAIL � ..
L
BLOCK TRACT „ .-. � ADDRESS
NO. OF BLDGS,
SIZE OE LOT " NOW ON LOT CITY
NO.
USE O E
BUILDIN 5--- -- — — DISTRICT ND. GRDUP CLASS NIAP .ftUavE'D BY
SK P
CONTRACTOR`.-^-'�--• ,. �7f,�`�
67
ADDRESS CONNECTION DATA
STA'itON ..DEPTH
CITY ? {. TEL:_NO. -_
PATE LIC "` UPPER
LICENSE NO: CLASS MANHOLE REFERENCE �'g � ----
Ct LOWER
NO. DESCRIPTION OF WORK FEE __-_-.---_..-_ __ -_ '�, f
_ _ - TYPE OF CONNEC7lO LENGj I FROM
HOUSE SEWER CONNECTING TO Y. CURB � M.L.TO P.L. �✓
15
I PURL C SEWER SS Do -_--- P.C.NO.
5FPi11' (ANK SEEPAGF PIT OR - -- -- JOB NO. _ --�
TS AND!OR DRAINFIELD. —C@' $10.00 —^_ _ CO.fMP_NO. C�',--__
HOUSE SEWERONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PR VATE C 1SPOCAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG OR _ � �a, AFFI3AVIT WAIVED� 6A5[MENIT RECORD.1NSTR.NO. ( DATE 0
WORK TO HOUSE SEWER S3-O0____! 6.+•1
..-_ SE . ____
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXT ty..CESSPOOL..DRYWELL..MANHOLE @ $5.00 j 9`l
.._ - -.__-_.__.___-.- .__-_.__-___- HWY.OR ST.WIDENING i0
ALTER,REPAIR OR ABANDON HOUSE ,
5E WER OR DISPOSAL SYSTEM @ 53.00 ----'-- ---'C----'
STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL.
! WASTE APPROVAL z
..__-_.__-__. CHARGES
OWNER'S PERMIT s QO - ------ — —---—--
AUTHOMATION TOTAL FEE L yF CONFECTION CHARGE FEE �-
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING --- --f- ------'— -
TO THE PUBL)c SEWER. APPROVALS DATE I INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF _.t9— ----------" "---- `— `
I
OWNER OR NEW HOUSESEWER I
OWNERS AGENT_ - --
------- --- CONNECT ADDITIONAL
BU IL_DI NG OR WORK
ADDRES —_
SEPTIC TANK SEEP..PIT(S)
I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION ANP/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .-- --- -- —.-- ---------
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ i 1 HEREBY CERTIFY THAT I .AM PROPERLY REGISTERED AND/OR ALTER, REPAIR,SEWER OR j
LICENStD AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM I
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DI SCONN ECT PLUG AND
RESIDE IN, THE ABO3(E DESIRIBEO RE$IDENIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE �'" _1=`_ SACKFILU SEPTIC TANKS i
'"r'— - ------------ SEEP.PITS) CESSPOOLS
77
VALMATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK. M.O+.^- CASH
d ! Wit'. a.4 ,. SJ U C a,wl i� All .
°"2APPLICATION FOR PERMIT
u
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER BUILD[NG
BUILDING AND SAFETY DIVISION
ADDRESS
LOCALITYE-
IV
NEAREST
FOR APPLICANT;TO,EILL IN
CROSS ST.
LEGAL L:. -
OE$GR(PTI ON
LOT NO. OWNER
MAIL
$L
4 .1{{ TRACT _ 0.bDRESr
NO OF BLDG5. )
512E OF LOT „ '. y NOW ON LOT TEI..
USE OF
BUILDINGS DISTRICT NO. G. MAP ESSEO BY
_ _ _ _ _ �+ 8K PG -F
CONTRACTOR
ADDRESS 6 v CONNECTION/DATA
CEYY -
,. !! '/ 6T _�.+.�.__— _
STATE LIC MANHOLE RE FERE NC E. u',� s` -
L:CEN-G NO. CLASS _. y 4k _ J'/ .. _ 40WER
NO.� DESCRIpTION OF WORK PEE rTYPOF CONNECTION 1 LENGYH FROM _
H OUSESEW
ER—O TO I Y. CURB P.L.'° M.L.TO P.L. ..�'
PU E HLIC SEWER I --- --- — j-
SEPTiC TANK SEEPAGE PIr 6R Y P.C.NO.
CO.IMP. NO. JOB NO.
P TS AND/OR DRAINF(ELD _ ------ -- O
HOUSE SEWER CONNECTING TO - TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL HLD G.OR AFF7DAV(T WAIVER E0.5 R'MENf - r
R11 NO DATE
WORK TO HUI..SESEWER @
OI ERF LOW SEEPAGE PIT.DRAIN FIELD _-_ _.__.__.__�______-
EXTN.,CESSPOOL.DRYWE'.LL.MANHO!E Q lit
kL"T BANOON HOUSE _ HWY.OR ST..WIDENING CL
SEWER O. AL.SYSTEM @ E`r STATE ENCROACHMENT ~ 0)
PERMIT NO.
-- INDUSTRIAL.
WASTE APPROVAL
"'-- CHARGES
++��OWNER`S PERMIT __ s '? -- - -- ---------- ------ ---- ----
AUTHORIZATION TOTAL FEE i0 CONNECTION C`HARGEFEE ----
i HAVE AT THIS DATE .4 CONTRACT WITH THE HEREIN NAMED CON= REIMBURSEMENT.F EE
TRA.CTv^R "0 CON
DATE INSPECTOR'S
THE ABOVE DESCRIBED EXISTING DWELLING ------- I ISPECTOR`5SIGNATURE
TO THE PUBLIC SEWER. APPROVALS I
SIGNED THIS_ DAY OF----19—
OWNER
F -_ 19_OWNER OR NEW HOUSE SEWER
OWNERS AGENT _—.--- -- CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS—_ ._.
-- - — --- '--'- SEPTIC TANK,SEEP,PIT(5) '-
IH
ACKNOWLEDGE THAT I' HAVE READ THIS APPLICATION AND/OR ORAiNFIELD I
AND fAll` r.HAT THE ABOVE 15 CORRECT AND AiREE T'O COMPLY ..-------
WITHALL COUNTY ORDINANCES AND. STATE LAWS REGULATING
PLUMB INC AND SEWERS. CESSPOOL_ D
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDI OR ALTER,REPAIR.SEWE
LR OR I�
CF NSEO AS REQUIRED BY LOS ANGLES COUNTY AND. STATE OF SEWAGE D SPOSA tSTEM
CA�i-ORNiA OR THAT I AM THE. LEGAL OWNER OF. AND INTEND 70 DISC ON NECT PLUG AND
RESIDE IN THE ABOVE DE GRISED RESIOENTIA<L PROPERTY.
.. ABANDON HOUSE SEWER I I
SIGNATURE
OF PER MFY7EE ,3 t�� S "' `L BACKF LL SEPTIC YANKS -- _--
r k-`-"�---'-"�°"— SEEP,PIT(5) CESSPOOLS
3,, V DATION
CK, ,fk.o. CASH
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