HomeMy Public PortalAbout9506 WEDGEWOOD ST_Sewer__ I)FPARTMENT OF COUNTY ENGIIITEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS 1.
FOR APP !CANT TO FILL IN LOCALITY � ,�t,,�_ j� `
BUILDING NEAREST /f
ADDRESS s1 _ _ CROSS ST.
LOCALITY/- DISTRICT NO. SERIAL NO. PERMIT N0.
C,
NEAREST
CROSS ST. 1 ---=�---
RE IVED,BY Ready for Inspection DATE ISSUED
OWNER S, ,// ryry
fir?
MAIL USE ZONE I OCCUPANCY MAP
ADDRESS eJ � ✓�� J SK fPG
/
CITY A TELAO.
CONTRACTOR CO.IMP.NO.
ADDRESS : JOB.N0.
CITY TELAO. TRUNK PERMIT NO, w v
REGISTRATION NO. EY-STATE
COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0._ - PERMIT NO. _
BLOCK TRACT „t. INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF SLOGS. CHARGES
NOW ON LOT
USE OF
BUILDINGS f CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
RElMBURSEIIIENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 '�`+ �� RECEIPT NO. IBY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO —
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 ! �„
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA _
SEPTIC TANK,SEEPAGE PIT OR / t
PITS AND/ORDRAINFIELD 2.00 STATION DEPTH t®
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 <,c� �, ," MANHOLE REFEREN11/��
O f R1 V-PIPER G f LOWER
TYPE OF CONNECTION LENGTH FROM
9fr-'
OWNERS PERMIT ; i 00
CURB--'-- ".Pa.:- M.L.TO P.L.
�
AUTHORIZATION i TOTAL FEE I I --
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.-.2 _DAY OF.......... ...... 19- NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT. -------- •' ref _ -.............. ._..•_
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.- =1 47•.'1_•t.,._................... .. AND/OR DRAINFIELD
1 HEREY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL 0
CATB
IONAND 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRISEllWIDENTIA� PROPERTY. BACKFILL SEPTIC TANKS E
f/// SEEP.PIT(S)C] CESSPOOLS El <a_ j!
SIGNATURE � ///' ' �+ ,; �,. �, ce
OF PER
MITTEE i i___:.• r.S. � X. C>_'_. ..___--_-__..
i GA642A 663 7/53