HomeMy Public PortalAbout9168 WEDGEWOOD ST_Sewer__ ��AC4XD APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Loa Angeles BUILDING , r ,r✓ fir`
ADDRESS <_
JOHN A. LAMB1E, COUNTY ENGINEER --- -:A
CASSATT E), GRIFFIN, SUP'TOF BUILDING LOCALITY
NEAREST
-- FOR APPLICANT TO FILL IN iS ST '�' " �.
LEGAL -
DESCRIPTION LUft`" L- `. OWNER e
_T NO.,¢` OVe
BLOCKADDRESS
TRACT •✓ - MAIL
-- - -'- �_ _ sem'.�`-
-._.__..-- � - _ .OF RLDGS; v
_ -- '. p°{ `.�i' NOW ON LOT CITY TEL. NO.
SIZE OF LOT a,,_. ^N -
BU.ELL NG;S Via.- � ' DISTRICT NO. - GROUP � MAP
-- --
RK PG
CONTRACTOR
_.,
CONNECTION DATA
ADDRESS
STATION } „• DEPTH .
CITY TEL. NO., .� r I'P 'd' ----- --------------- ---- --.
--- ------- -�"&— -- .--- MANHOLE REFERENCE •.�Ia1'Jk,
STATE '�- v LOWER
- �'�'� ,✓'� -
REGISTRATtO?i N0. COUNT}-
-
N
NO. f D£SCR I r r I O�i OF WORK _ FEE -- -- -----------------------------_.------------
-� - f---- -- TYPE OF CONNECTION LENGTH FROM
9 HOUSE SEWER CONNECTING TO Y. CURB P.L.--. IvI,L. TO P.L.
`. PUBLIC SEVER @ $ .-`..ts - ---------- -------- -- ---
5EPTIC TANK SEEPAGE PIT OR
j-PITSAND/OR DRAINFIELD ce, $3_00
-_
OVERFLOW SEEPAGE PIT,DRAINFIELD C P T NO. n -
EXTN.,CL POOL.DRYWELI.,NIATIHOLE ((q $2.00 CO. IMP, NO. JOB NO,
HOUSE SEWER CONNECTING TO I
_ PRiVAT'f.DISPOSAL SYSTEM (i' '1 00 j _; TRUNK PERMIT NO. ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG,OR i STA'L'E ENCROACHMENT -
WORK TO HOUSE SEWER Via. $1.00 I PERMIT NO. _
j ALTER REPAIR OR ABANDON HOUSE I INDUSTRIAL
SEWER OR llISF0561.SYSTEM. ---,-r .�1.00 WASTE APPROVAL
i
CHARGES
-- -- _-------- -_-.— _ CONNECTION CHARGE FEE
OWNER'S PERMIT �� _ _.�._, –— -- -------- - -----
.00
REIMBURSEMENT FEE
AUTHORIZATION - OTAL 1'EE �� A
I HAVE AT THIS DATE A CONTRAc P WITH THE HEREIN NAMED CON APPROVALS ! DATE IINSPE,O.TOR'S Si GiFA"iURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
---------RO----- - TE --------.--..._ -----..
TO THE PUBLIC SEWER, NEW HOUSE.SEWER i i -
SIGNED
CONNECT ADDITIONAL
OWNER OR � BUILDING OR.WORK
OWNERS AGENT �+'
- SEPTIC TANK,SEEP.PIT(S)
.AND/OR DRAiNFIELD
„DDRESS __ '
1 i-IERERY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONI
AND STATE THAT THE ABOVEISCORRECT AND ACRES- IO. COMPLY
- CESSPOOL,L� DRYVJELL❑ r
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR �
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM f
I HEREBY CERTIFY THAT I AM. PROPERLY REGISTERED AND!OR DISCONNECT PLUG AND ---f------ -------------
LICENSED AS REQ UIRED BY LOS ANGLES COUNTY AND STATE OF ABANDON HOUSE SEWER _
CALIFORNIA OR THAT I AM THE LEGAL. OWNER OF THE ABOVE -- - -a- -.--- ---..-- ---
DESCRIBED RESIDENTIAL PROPERTY ., BACKFILL SEPTIC TANKS❑
SIGNATURE "� �� SEEP.FITS)Cj CE_SPOOLS_E] � --.__------ _
OF PERMITTEE -- ----
IOH Nt A. LAMBIE,COUNTY ENGINEER VALIDATION ROBERT A.WOOS, CHIEF PLBG, INSPECTOR
DF.IPAR OF COUNTY ENG]NVEEB SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES —
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADORE88
FOR APPLICANT TO FILL IN LOCALITY �Q
ADD ESS �^! r rA lira® s. CROSS ST.- ,
LOCALITY l> 61STRI�10. SERIAL NO. PERMIT NO.
NEAREST p S A / �/ �''� S
CROSS ST.
OWNER`IO�/9,fC,: c f D BY Ready for Inapeotlen / DATE ISSUED
/".�/ I�rSIY.fGQ�/C� CEIVE�
MAIL �/� �s USE ZONE CCUPANCY MAP
ADDRESS ��Y� y., /gpp��j�,�y�� � + BK ] PG
CITY t°�14 C TEL.N0. %/et1/ ••—1 I ( .
CONTRACTOR: . , 00:IMP.NO.
ADDRESS r)�
�� �Q� ��� JOB.NO. - �+
CITY 247 � TELAO. 4e�vt
TRUNK PERMIT'N0.
REGISTRATION NO. �� COUNTY
ROAD PERMIT NO.
LEGAL �� d
DESCRIPTION LOT NO. STATE ENCROACHMENT, PERMIT NO.
BLOCK TRACT 01 AZ e'., INDUSTRIAL
WASTE.APPROVAL
SIZE OF LOT NO.OF SLOGS.
7" U NOW ON LOT / �- CHARGES
USE OF
BUILDINGS �J` `� /' CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT:FEE le
HOUSE SEWER CONNECTING TO !!� �!
PUBLIC'SEWER 3.60 .r/ RECEIPT NO: I 1, DATik I BY
HOUSE SEWER CONNECTING TO t
PRIVATE.DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG:OR EXCEPTION ECORDED
WORK'TO HOUSE SEWER1.00
ALTER OR REPAIR EXISTING NO. I ATEA (BY
SEWER OR DISPOSAL SYSTEM 1.00 `
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.06 _ CONNECTION DATA.
SEPTIC TANK,SEEPAGE PIT OR -- ` �I
PITS AND/OR DRAlNFIELD 2.00 STATION ,�. � - DEPTH
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS.ONLY 2.00W_ 11134t' At
- 1340 MANHRO REFERENCE OWERs
l TYPPE OF - INECTION LENGTH FROM n ,
OWNERS PERMIT $ I I 00 `UR —P L.
M.L.TO.P.L. f�
AUTHORIZATION . TOTAL FEE C ��=
1 NAVE THIS DATE CONTRACTED' WITH THE. HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS' INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS......��._DAY OF.... .._._.......lip NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.__ r / � ......... BUILDING OR WORK
I ��� _.... ._..:� _.._..._
SEPTIC TANK;SEEP.PIT(S).
ADDRESS............:.._.:.. ......._........ ___._..........._..........6...._........._. AND/OR DRAINFIELD
1 HEREBY'ACKNOWLEDGE THAT 1 HAVE READ THIS:APPL1= CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND-SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE'OF CALIFORNIA OR THAT I AM THE LEGAL_OWN-
ER OF THE ABOVE ESCRIBED RESIDENTIAL PROPE PTY. BACKFILL SEPTIC TANKS
81GNATURE e �}� �a �
SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE.:. ...s..._._: 'G_�L::.•
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