HomeMy Public PortalAbout9202 WEDGEWOOD ST_Sewer__ DEPAH OF COUNTY'ENGINEER i - •SE' E'R—SEWAGE DISPOSAL'' 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS.ANGELES j; BUILDING
WILLIAM J. 'FOX, COUNTY ENGINEER f• I ADDRESS 9Lll�DD is
FOR APPLICANT. FILL IN L ALITY -
BUILDING EAREST
ADDRESS D I t- ` CROSS ST. _ 9'12"d Al
LOCALI l�.Q� ,� DISTRICT 0._ SERIAL NO. - PERMITgNO../
CROSS ST.. l✓� IiG�J' / _-2A - rte) O .��✓�]1
RECEIVED BY Rekdy tar Inspectlon 1�DDATE'ISSUED.
OWNER
MAIL- USE ZONE OCCUPANCY MAP
ADDRESS / y7 L BK PG
CITY TEL.NO. d ' AIR)
R)�
CONTRACTOR CO:IMP.NO.
ADORES&,/&—;g4,q JOB N0.
EL.
CITY.. -,F, C 7 i �� NO. dw �� , TRUNK-PERMIT NO.
COU TY/
REGISTRATION NO. ROAD PERMIT NO. 2'7 556 49.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
�J� a� PERMIT NO-.
BLOCK TRACT `% d INDUSTRIAL
r WASTE APPROVAL
SIZE OF LOT. A J NOW ON LOTS CHARGES
USE OF � � �,�/� �
BUILDINGS �i/e�Fr CONNEC CHARGE FEE
NO: DESCRIPTION OF WORK FEE ;
HOUSE SEWER CONNECTING.TO REIMBURSEMENT
PUBLIC SEWER 0 $ .3.50 RECEIPT NO. ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM, 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORD
WORK TO HOUSE SEWER " • 1.00'
ALTER OR REPAIR EXISTING NO-•I'• DATE I BY
SEWER OR DISPOSAL SYSTEM IAO
-DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA -
SEPTIC TANK,SEEPAGE PIT OR �.
PITS AND/OR DRAINFIELD 2.00 STATION. I/•p� �ry DEPTHr
SPECIAL CONDITIONS ONLY 2.00 ANHOLE REFERENCE
11 t.J dY• o� U mw LOWER
TYPE OF CONNECT LENGTH FROM
OWNERS PERMIT S. I 00 Y. CURB / P.L. M.L.TO P.L. /
d• ,
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE:DESCRIBED EXISTING APPROVALS INSPECTOR;g INSPECTOR; SIGNATURE DATE
DWELLING TO THE PUBLIC SEWS
SIGNED THIS_L—P...D Y'O.F.. �•� .19 � NEW HOUSE.SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.._ ....... _ BUILDING OR WORK
ADDRESS..._..... ..Gail_ AND/ OR DRAINF ELEPTIC TANKD IT(S).
1 HEREBY KNOWLEDGE THAT-1 HAVE READ THIS APPLI. i 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ;DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON N.OUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN-
ER OF THE ABOVE D CRIBED R ENTIA' PROPERTY. ;BACKFILL SEPTIC TANKS�
SINATURE SEEP.PIT(S)o CESSPOOLS �r {•a ,:�
E�r�F- f
OFGPERMITTE ... ._ .�.._.._.._._..__-.-.._.
76A642A 663 7/53