HomeMy Public PortalAbout9211 WEDGEWOOD ST_Sewer__ E808 5-65
bA642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOIIN A. 1AMME. County KnIzine,r ADDRESS q2ll-E. 1vv[ela'g6r,,--cI3d
COIY'�IAN W. JFNKINS.Sup't. of Building 4 V
LOCALITY
NEAREST
CROS ST.
FOR APPLICANT TO FILL IN nn
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NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY NO.
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LICENSE LICENSE
NO. J 10 CLASS MANHOLE REFERENCE LOWER
No- DESCRIPTION-OF WORK FEE TYPE OF CJ)4�CTION LENGTH FROM
I HOITSE SEWER —i
5 Y M.L.TO P.L.
PUBLIC SEWER $ 5.00! on-) — -E >-
P.0 NO.
P12.
ITS ANO OR 'DRAIN IE. $1 0.001 CO,IMP.NO.
JOB NO.
0
HOUSE SEW Rco-NNE6T NGTQTRUNK PERMIT NO. PERMIT NO
$ 3.001;
PF?;VA.E OISPOSAL SYSTEM
co-k-Nbf'r Abbi ----T—RFCORD. INSTR.NO. DATE
FVER! NT
WORK TO HOUSE SEWER 3.0 AFFIDAVIT WA I 14SIl
SEWER OR DISPOSAL SYSTENII 3.001 uj
7—
HWY. OR ST.WIDENING-U-VrwF L Olff-Sr"KG-r-rTT-,-n-qA rN-nTL 0 -- 7-- 7
EX"I L, MANHOLE $ 5.00
STATE ENCROACHMENT z
1 PERCOLATION TEST $ 5.OG PERMIT NO.
INDUSTRIAL
7 WASTE APPROVAL
CHARGES
MIT
j CONNECTION CHARGE FEE
' PERMIT
-7-2 00
_-_-
OWER'S
AUTHORIZATION TAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- HE I MSURSEME�NT FEE
TRACTOR
CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
To THE FUSLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19---
OWNER OR1 /,'� / U
NEW HOSE SEWER
OWNERS ADEN
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP.PIT(5)
1 HEREBY A--KNoWt-CDGC THAT I HAVE READ THIS APPLICATION AND OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE To COMPLY
WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.
IRS. CESSPOOL D DRYWELL El
I
I HEREBY CTHAT FY ERTIAM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORN:A OR THAT I AM THE LEGAL OWNER 0 AND INTEND TO -cTlsCi0--N-NECT-P—LUG-- AND
RESIDE IN. THE ABOVE. ES P,IBEU RESIDENTIAL PROP TY, ABANDON HOUSE:SEWER
SIGNATURE
OF PERMITTEE: BACKFILL SEPTIC TANKS
5EEP,PIT(5) ❑ CESSPOOLS ❑
VALIDATION
CK. M.O. CASH
Lfi,o-9 8 7 4 jLL D