HomeMy Public PortalAbout9240 WEDGEWOOD ST_Sewer__ DEPA3iTRIENT OF COUNTY ENGENEER SEWER-SEWAGE DISPOSAL-� DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
0 WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGNEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST ` "'� A Z5C✓WlJ J
CROSS ST. A
R ly D B Ready for Inspection- DATE ISSUED
OWNER a/�
P
MAIL p- OCCUPANCY MAP
ADDRESS A USEZOE PG
CITY TELAO. r�
CONTRACTOR Ga '
CO.IMP.NO.
ADDRESS JOB NO.
CITY TELAO. ai+�®� TRUNK PERMIT N0. �®
'S -
REGISTRAT N N0. �� COUNTTATEY ROAD PERMIT NO. �1
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT �4- 11% -S. INDUSTRIAL
�.
SIZE OF LOT _ N0.OF BLDGB. WASTE APPROVAL
NOW ON LOT CHARGES _
USE OF
BUILDINGS PLy LO
TION CHARGE FEE
NO. DESCRIPTION OFVd K FEE
HOUSE SEWER CONNECTING_ TO
REIMBURS T FEE
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. DATE 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 EXISTINGNO. I DATE' 1-13Y
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW E LL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFS
UPPER LOWER
TYPE OF CONN TIO LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB L- M.L.TO P.L.
AUTHORIZATION TOTAL FEE `� 0 0-
1 HAVE 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 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT....,..._.._.................................._.................... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS......................................... ...................................._..... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND LICENSED AS REOlU1RED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY: BACKFILL SEPTIC TANKS(]
SIGNATURE SEEP.PIT(S)[_-] CESSPOOLS
OF PERMITTEE
T8AM211 863 1/53
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES `
. WILLIAM J. FDX, COUNTY ENGINEER I BUILDING
' ADDRESS
r
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS _ CROSS ST.
LOCALITY DISTRICT NO. A SERIAL NO. PERMIT NO.
A
NEAREST S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
BK PG
CITY TEL.NO. .
CONTRACTOK
CO.IMP.NO.
ADDRESS
JOB.NO.
CITY TEL.NO., TRUNK PERMIT NO.
STATE
REGISTRATIONNO. COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL s
SIZE OF LOT NO.OF BLOGS.=
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC_SEWER @ S 3.50 f RECEIPT N0. I DATE BY
HOUSE SEWER CONNECTING TO 4
PRIVATE DISPOSAL SYSTEM 1.00
COMNECTADDTIONAL BLD&.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I DATEI BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT N
AD ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 j CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 ( STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I. MANHOLE REFERENCE-
,— LOW'E_R
TYPE OF CONNECTION LENGTH FROM
OWNERS # � 1 00
Y. -- CURB P.L. M.L.TO P.L.
PERMIT -
AUTHORIZATION TOTAL FEE I -
I HAVE 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:. . ..............IS_:...:- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT -------------...-...--..................-......
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..------- --•---............ -..................•----.......................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 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
1 HEREBY 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[I CESSPOOLS
OF PERMITTEE- �---..-----...............--------
76AG42D 663 1/53