HomeMy Public PortalAbout9246 WEDGEWOOD ST_Sewer__ ' eC8 °
kEti_57 APPLICATION FOR PERMIT
�eoa
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
IF .
JOHN X LAMBIE, County Engineer -
CASSATT D. GRIFFIN. Supt of Building _LOCALITY r �
tz-
NEAREST ;
FOR APPLICANT TO FILL IN CROSS ST. r 'ee� ,Y , ,
LEGAL -
DESCRIPTION LOT NO. ":j OWNER ti
BLOCK 'TRACTMAIL f
ADDRESS. _
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT J� CITY TEL.NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BIS PG
CONTRACTOR ..��_ •.�' " �' ,s97y + " - ,.JS
ADDRESS , ; = �:- y CONNECTION DATA
CITY';� y" x�",�- TEL.NO.� n Cdr-J STATION DEPTH
STATE. ~MANHOLE REFERENCE UPPER
REGISTRATION NO. i.�-'�. ,'!'' ^COUNTY
No. --DESCRIPTION OF_WORK FEE ---
y HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $---SQ -----
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD {, $3.00 Y. 'CURB ,: P.L. M.L.TO P.L_.,___,
OVERFLOW SEEPAGE PIT,DRAINFiELD I---
EXTN.,CESSPOO_L,DRY_WELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO F C. N0,
-PRIVATE DISPOSALSYSTEM @ $1.00 CO.IMP.NO. ; _ JOB N0,
( CONNECT ADDITIONAL BLDG.OR - - � _------
I WORK TO HOUSE SEWER_ @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE - - ---- .
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT -
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER'S
L�NLeR,S c ENRAGES
PERMIT O0 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I RFIMEURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE dINSPECTOP.'SSIGNATURE
TO THE PUBLIC SEWER. -
✓4
SIGNED T1-lISDAY OF —19 NEW HOUSE SEWER ,I�.- ----
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT "'
BUILDING OR WORK _
ADDRESS 4�,/_� � d ','"�' ' _ SEPTIC TANK,SEEP,PIT(S)
�~ AND/OR DRAINFIELD _
II HEREBY !(!KNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL 0
WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBINGAND SENERS. ALTER,REPAIR, SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE-DISPOSAL SY'STEM�- A�
LICENSED AS REQUIRED BY LOS ANGELES. COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR 'THAT I AM THE LEGAL OWNER OF THE ABOVE' ABANDON HOUSE SEWER
DESCRIBED RE .IDENTIA ❑- OPERTY. BACKFILL
SIGNATURE .i'./
SEEP. PITS) Q CESSPOOLS _
OF PERMITTEE -_ —
�� t VALIDATION ROBERT A. WOOD
M.0. CASH SUPERVISING MECHANICAL ENGINEER
s'
76ABA$A �.
�E6o6.6ets6 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILnING '
BUILDING AND SAFETY DIVISION ?
ADDRESS . .:t ,.yV�"" %, 1.� 71JOHN A. I;AMBIE. County Engineer
�
CASSATT D. GRIFFIN.Sup't of Building LOCALITY a �'
NEAREST
FOR APPLICANT TO FILL, IN CROSS ST
LEGAL / r t t °
DESCRIPTION LOT N0. !i � } ,} cT� 3 L OWNER s" .•moi _ ('' ,°. @�
FLOCK TRACT ar '' MAIL
ti ADDRESS
{ NO.OF BLDGS. 9
SIZE OF LOT Jy J 4 NOW ON LOT :�. C y ,
ITY s s TEL.NO.
_SIZE
OF yy J f t
BUILDINGS Di.STRIGT N0. GROUP BIS MAP PC PROCESSED BY
CONTRACTOR
.DDRESS lk,Lys r� C NNECTION DATA
CITY -*'i° TEL.NO. ` STATION DEPTHSTATE
REGISTRATION 140. j COUNTY MANHOLE REFERENCE UPPER
NO. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER 0 $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF TION LENGTH FROM
ITS AND/OR DRAINFIELD @ $3.00 'r^ : P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL,DRYWELL,MANHOLE @ $2.00 .
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Cj $1.00 CO.IMP.NO. �iJOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ MOO 1 - TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER, REPAIR OR ABANDON HOOSE @ .STAT£ENCROACHMENT r�
SEWER OR DISPOSAL SYSTEM $1.40 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OWNER'S PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ,'j I EEIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS AY OF Ig® NEW HOUSE SEWER _
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT- / } j t EUILDING OR WORK
ADDRESS > L/ 1' £ SEPTIC TANK,SEEP:PIT(S)
{ -i a, ltS —..._( .Jv�'�_ '---, AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS pppsn - TON
AND STATE THAT THE ABOVE IS CORRECT AND AGI&RE TOeC LY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT AND
.M�
LICENSED AS REQUIRED BY LOS ANGELES COUN CT PLND STATE OF ABANDON CT PLHOUSSEWER
CALIFORNIA OR THAT I fi `-THE LEGAL 0 OF THE ABOV -
DESCRIBED RESIDENTIAL'PROPERTY. BACKFILL SEPTIC TANKS 0
c, _.
SIGNATURE SEEP,PITEl S? CESSPOOLS r'
� iy - �.-. q�-p
OF PERMITTE �F
YAdDATIO ROBERT A.WOOD
., E,per ' SUPERVISING MECHANICAL ENGINEER
`i aS.