HomeMy Public PortalAbout9227 WEDGEWOOD ST_Sewer__ 76 A 6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPART14ENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
,
JOHN A. LAMBIE, County Engineer ADDPESS Q
WILLIAM A. TENS EN, Supt of Building
j-
N
_LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS T.
'DESCRIPTION LOT NO. .-NIF.R
-4
MAIL
BLOCK TFIA:=T AODRESS
NO. OF SLOGS.
sl:�c OF LOT NOW ON LOT -ITV ,P)f TEL . No. Ar, e�
USE OF
5 UILDINGS DISTRICT NO. GROUP] MAP PROCESSED 13Y
ali Q
5K P
CONTRA CTORI
ADDRESS CONNECTION DATA,
CITY TEL-. NO. STATION DEPTH
STATE
REGISTRATION NO. COUNTY MANHOLE REFERFNCL LOWER
NO. 1DESCRiPTIONOFWORK---FEE 'TYPE OF LENGTH FROM
S EWER CONNECTING TO T Y. CURB L. M.L.TO P.L.
1Pi1-Jf�3-1L-IFC SEWER @ $5,00
P.C.NO,
,-PTIC TANK.SEEPAGE P!T OR CO. IMP NO. -IDf3 NO.
AND`OTR DRAfNFILL0 $10,00 i.
1 -Q u,SF:s,Fw E Rc—ONNE.-C-r I N�fb
TRUNK PERMIT NO. ROAD PERMIT NO,
PRIVATE DISPOSAL SYSTFM C S3.00
CONNEC A DID IT JON-k
WORK HIDUSE SEWER 4.3.00
OVERFLO�VV-IFEF�AGE PIT,DRAiNFIELD
DRY WELL,MA N�IOLE @ A5.00_
HWY.Of'.5T.WIDENING
ER
S F.W I-IR DiSPOSALSYSTEM $-1.00STATE ENCJ. ROACHMENT
PERMIT NO'. ------
INDUSTRIAL,
4
AS7E, "RrO�11
$ 4L
--------TRiR
-W
OVVNI: S MIT
CONNECTION CHARGE�tF
AUTHORIZATION TOTAL FEE b
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTiNG DWELLI±LG
TO THE PUBLfC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS—_DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS
CONNECT ADW71ONAL
BUILDING OR W
SEPT]C-LANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGZ THAT I HAVE READ THIS APPLICATION
AND"OR DRAINFIELD
AND STATE THAT THE ABOVE tS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY OkDiNANCES AND STATLAWS REGULATING
PL 11M13'NG AND SEWERS. CESSPOOL 1:1 DRYWELL L
HEREBY CERTIFY T�4fi' I AM PROPERLY PIGISTFRED AND/OR ALTER,REPAIR.SEWER 04
1 1 i
L(CFNSLO AS REOUiRED BY LOS .ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
GALT
ALIFORNIA OR THAT I A14 THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THU. ABOVE DI�SCRIBED RFSIOENIIAL P( A15AND ON H
SIGNATURE dZv 0PEPTY. OUFIESEWER
0 PERM ITTEE C, UACKFILL SEPTIC TANKS
F SEEP,PIT(s) El CESSPOOLS
VALIDATION-, ROBERT A. WOOD
CK- M.0. GASH SUPERVISING MECHANICAL ENGINEER
,BA
E-663 17.55 APPLICATION FOR PERMIT 1
3&E-86
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING; f'
JOHN A. LAMBIE, COUNTY ENGINEER
l CASSATT 10. GRIFFIN, SUP'T OF BUILDING
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN _CROSS ST.
LEGAL - - OWNER
DESCRIPTION LOT NO. OWNE
BLOCK TRACT, ADDP.ESS MAIL -�._...
-- — -- - y_
.. f
NO.OF BLDGS. a 4.r ,
.SIZE OF LOT NOW ON LOT CITY _.,,,,.--:" �.-$`.. � . "'t NO.,
USE 4F�"-� - _-- DISTRICT NO. GROUP MAF
BUILDINGS � i o' _ ! BK PG
CONTRACTOR ''r'._..�.•+'"i?' .. -;-r .' ,,.- $
ADDRESS _ CONNECTION DATA
—
.,> . cGe y
_STATION `y jf' r�-- DEPTH
CITY_ �`3 O� TEL.NOq :r -�
-- MANHOLE REFERENCE / I- _
C< s At " - STATE . .:'__ •_'I-
1,
,.:c�-_
REGISTRATION NO. �.. .1 40,, :�L E] COUNTY --�--A._—�- - - _-
NO, 1 DESCRIPTION OF WORK FEE - - - --
HOUSESEWER WER CONNECTING.TO T I •�� TYPE OF; CTION .LENGTH FROM i
Y, CURB P.L. 14,L.TO P.L. =_
_
PUBLIC SEWER @ $_3.50 _ �'f., - _' - ---
SEPTIC TANK SEEPAGE PIT OR — �
_ PITS AND/`1R DR_AINFIELD _ _(rt $3,00 _
iOVERFLOW SEEPAGE PIT, DRAINFIELDP. C. NO.
EXTN„CESSPOOL,DRYWELL,MAN HOLE [t $2.00( CO. IMP, N0. 'v J �° JOB N0. -
_-
HOUSESEWERCONNECTINGTO J r
_ PRIVATE DISPOSAL SYSTEM _ - -c $i_00 - TRUNK PERMIT NO ROAD PE_RMIT_NO_4-w -Y w �
-� CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT _
WORK 70 HOUSE SEWER : S 1.00 I _ PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE `-- -- --------- ----
INDUSTRIAL
SEWER OR DISPOSAL SYSTEM is $1.0 iWASTE APPROVAL
! CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT oo ------- ----------
--- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE J-0
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS. 1 DATE i NSPECTOR SsIGNATURE
.TRACTOR TO CONNECT' THE ABOVE. DESCRIBED EXISTING DWELLING I
1'0 THE PUBLIC SEAFR. NEW HOUSE SEWER
SIGNED THIS DAY OF 19- CONNECT ADDITIONAL
OWNER OR - BUILDING OR WORK
OWNERS AGENT ` - --- --- -— -
^d .. SEPTIC TANK,SEEP,PITS}
ADDRESS ._ AND/OR DRAINrI[LD {
I HEREBY ACKNO'A'LEDCE THAT 1 HAVL READ THIS APPLICATION CESSPOOLr I -
A14D STATE TH?IT THE ABOVE 15 CORRECT AND AGREE TO COMPLY DRYWELL�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING `ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL_SYSTEM_ _
9 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND i J�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
ABANDON HOUSE SEINER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE: ---- -- —
DESCRIBED P,ES9DENTiAL PRC-PERTY. ,,Coy PBACKFILL SEPTIC TANKS l� �.
SIGNATURE - ~-' SEEP.PIT CESSPOOLS
OF PERMITTEE s �' >
T I
1
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION' � ROBERT A. WOOD, CHIEF PLBG. INSPECTOR