HomeMy Public PortalAbout9230 WEDGEWOOD ST_Sewer__ E8083-62' w APPLICATION FOR PERMIT
6A842p --
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER BUILDING
r + sI r
BUILDING AND SAFETY DIVISION ADDRESS .�rL,
JOHN A. LAMBIE, COUNTY ENGINEER �i
COLEMAN W. JENKINS. SUPT, Or BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS
LEGAL-- _—_--/`L I -- OWNE
DESCRIPTION LOT NO.
MAIL '
BLOCK TRACT (4_ F51�� ADDRESS3 `!,�
SIZE OF LOT �� /� Ir��_NOW ON LOT CITY,
USE OF - DtSTRICT NO. ROUP MAP PROCESSED BY
BUILDINGS — .� BK PG
CONTRACTOR
ADDRESS— CONNECTION DATA
STATION _ �.r ..." _ DEPTH
CITY TEL. NO. f' UPPER
STATE — LIC MANHOLE REFERENCE
No .DESCRIPTION OF W _
ORKF "yJ 3 POWER
LICENSE NO, CLASS
— ---- � EE TYPE OF_Cfg � N -_„ LENGTH FROM >,,,
M.L TO P.L. 5 0.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $5.00 P.C.NO. V
SEPTIC K.SEEPAGE PIT OR 1 i_ JOB NO.
TAN �!
1 CO.IMP. NO.
#PR
TS AND/OR DRAINFIELD $10.00 I Ix
USE SEWER CONNECTING TO I TRUNK PERMIT NO, ROAD PERMIT NO, 0
IVATE DISPOSAL SYSTEM $3.00 1"-
-- OR FFIDAVIT WAIVEREAb[ME xT RECRD.INSTORK TO HOUSE SEWER $3.00
jOVERFLOW SEEPAGE PIT.DRAIN FIELD
EXTN..CESSPOOL.DRYWELL,MANHOLE $5.00 z
_ HWY.OR 5T.WIDENING
ALTER.REPAIR Oft-
;?(BA;?(A-_NDO OUSE �,,, ____
SEWEF..OR'D fb`POS�CL SY _ _ 0 $'3.00 __ STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL _
WASTE APPROVAL
/�T�p CHARGES
O Y��Y IER�S _PERMIT $ 2 �D CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE -
REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
T
RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING — APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF-19— EW
F 19—
EW HOUSE SEWER —
OWNER OR
OWNERS AGENT_ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESSSEPTIC TANK.SEEP,PIT(5)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD ..._-_
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ElDRYWELL ❑ __..--___
PLUMBING AND SEWERS. ------------- -- —
1 HEREBY CERT Y THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LI';ENSED AS R OU}RED BY LOS ANGLES COUNTY AND TE OF SEWAGE DISPOSAL SYSTEM'
CALIFORNIA O THAT I AM THE V€GAI,O NER�.AF, AMD I NO TO DISCONNECT PLUG AND r�S
RESIDE IN, TH .AB-VE DESCRIB D RAS D � PR OPERT ABANDON HOUSE SEWER
S'(;NATURE T BACKFILL SEPTIC TANKS ❑
(IF PERM1TT _ � - — -- SEEP,PIT(5) ❑ CESSPOOLS ❑I
„,VALIDATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK. 1 M.O. CASH
7 4 6 1'"& DEC 2 1 D 5.00-
.44
.0ON
A64 I°-6'
APPLICATION FOR PERMIT
sa.sazo j
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION T
LDING
JOHN A. LAMBIE, County Engineer RESS
WILLIAM A. JENSEN, Sup'1 of Building _
LOCALITY
REST
FOR APPLICANT TO FILL IN SS- ST
LF GAL
DF_SCF!FT:0N LOT NC1, OWNER
MAIL
BLOCK TRACT ADDRESS
NO. OF HLDGS,
SIZE OF1 "T NOW ON LOT CITY TEL. NO.
USE C
BLI;LDiN'GS DiSTR(CT NO. GROUP MAPPRs ci SSED BY
_- __-- _ _.- 1-_ - .__ - ._ G
CONTRACTOR
ADDRESS CONNECTION DATA
STATION !� DEPTH
CITY TEL NO, -
T r -STATE 'E
REGISTRATION- NO COUNTY MANHOLE E-R.EFERER{C$ p I-
. yB, _ 6✓e 'v,L.. LOWER
No. DESCRIPTION OF WORK rE:E TYPE OF CON EGT\iON LENGTH FROM � 3
HOUSE.SEWER CONNECTING TO � Y. -f'U RB ,,� P.L.. M,L TO P.L.
SBLISEWER - -- __
I
JOH NC
PANDOR INFIELDUPTCO.IMP. NO
-
DRA
IT,
HOUSE 5. WER.CONN i PN.G TO TRUNK PERMIT NO. ROAD PERMIT NO.
' PRIVATE DISPOSAL_SYSTEM $3.00 e'er
-_ - '---_ - ---. - -
rCONN CT ADDITIONAL HLOG OR AFFIDAJIT i Wh1VEB EASEMEIeT RECORD.(NSTR NO. DAT'F_
WORK TO HOUSE SEWER � $3.00
-- - - -- - —
L l
OJERF LOW AUE PIT,DRAIN FIELD �� _- ... _;. L 4
EXTN_,r-ESSPGOL,DRYW€L.L,MANHOLE @ $5.00
�--- N - HWY. OR ST.WIDENING
A
.i FL7 ER,REPAIR 9A BADON HOUSE - — — �9
j
SEWER OR DISPOSAL SYSTEM S3.00 STATE ENCROACHMENT
_- �- PERMIT NO.
INDUSTRIAL
WASTE APPROVAL.
OWNERS _PERMITCHARGES_ $ 2 oo --- --- - ---- — --
*�+�y fir*/ _
A��4J HORIZATION TOTAL FEE_--_.—_ CONNECTION CHARGE PEE
1-7
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REiMHU Rfa._M ENT FEE
TRACTZJR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ---- '---ty-7---�v----+'----------^ ---- -----'--'
70 ',14E PUBLIC SEWER. APPROVALS DATE INSPECTOR'S.SIGNATURE
SIGNED THIS GAY
OWNER OR NEW HOUSE'.SEWER
OWNERS AGENT_-_, --- CONNECT ADDITIONAL
BUILDING OR WORK r -
ADORESS.-_-.
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THlS APPLICATLON SEPTIC TANK.SEEP,PIT(S)
ANDIOK DRAINFIELD )
AND 5TATE THAT THE ABOVE IS CORR FC'r AND AGREE TO cc�MPLY .— ----�--.J
WITH .ALL COUNT- OROINANCF'_S AND STATE LAWS REGULATING 1
PLU MBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
C
HEREBY CER IFY THAT s AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR —
tkCENSED AS REaUIRF_D BY LOS ANGLES COUNTY AND STATE ^.r SEWAGE DISPOSAL SYSTEM
,
,ALIrDRNiA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO -------- -"-- s'---�--'"-e--" --�—'-
ES"IDE IN, THF ABOVE R.
DESCRIBED E$I.DENTIAL PROPERTY. DISCONNPCT PLUG ANO I.
ABANDON HOUSE SEWER
SIGNATURE BACKF'IL!_SEPTIC.TANKS
CI" PERMITTEE - -_-_ _ _ _ _- —.-__ _ SEEP.PIT(5) ED CESSPOOLS ! �
VALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
;�ei.ly-- � G�' ,,,,, � 1, t� i? !~� .L � � s.3 � 4w.•. `sem 'y':�