HomeMy Public PortalAbout9529 WEDGEWOOD ST_Sewer__ X808-D
ca�sa APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS t o a' a'' r •e
JOHN A. LAMBIE. County Engineer
CASSATT U. GRIFFIN, Supt of Building LOCALITY v
NEAREST
7PT
OR APPLICANT TO FIM IN :ROSS ST.
LOT NO. !�' ✓ ry « ✓' OWNER y
TRACTMAIL_ • ✓ ADDRESSN0.OFBLDGSNOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS ' _ r DISTRICT N0. GROUP! MAP PROCESSED BY
CONTRACTOR d p ! BK PO
5
ADDRESS $ C NNECTION DATA
s'� _ . ..
CITY' �..� - a . - �"« TEL.N0. ff ,,� — �.. STATION � L�r� a. DEPTH
REGISTRATION N0. { - COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE " wER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 �'1 e-c,^
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CO CTION LENGTH FROM
PITS AND/OR DRAINFIELD @ MOD �� P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL,DRYWELL,MANHOLE 0 MOO
HOUSE SEWER CONNECTING TON0.
PRIVATE DISPOSAL SYSTEM (� $1.00 CO.IMP.NO. ,��,,? & J08 10.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO ROAD PERMIT N0,
WORK TO HOUSE SEWER. $.1.00
ALTER,REPAIR OR ABANDONHOUSE STATE ENCROACHMENT
SEWER 6R DISPOSAL SYSTEM $1.00 PERMIT NO.
INDUSTRIAL
'HASTE APPROVAL
s CHARGES
OWNER'S° PERMIT s 2 00
CONNECTION CHARGE FEE
I
MORIZATION TOTAL FEE g,-o REIMBURSEMENT FEE
AVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALR DATE INSPECTOR'S SIGNATURE
Af
ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
THE PUBLIC SEWER.
GNED THIS—Z F DAY OF�r'-- �19�r NEW HOUSE SEWER
NER OR CONNECT ADDITIONAL
NERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
AND/OR DRAINFIELD
HEREBYACKNOWLEDGE THAT 1 AV£ READ THIS APPLICATIOND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL L DRYWELL❑TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
UMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
ENSED AS REQUIRED BY LOS ANGELES COUNTY ANDSTATE OF ABANDON HOUSE SEWERLIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVESCRIBED RESIDE t PROPERTY BACKFILL SEPTIC TANKS3' SEEP.PITiS CESSPOOLSNATUREF PERMITTE
R -VAIMATION ROBERT A.WOOD
R.Q. CABS SUPERVISING ME"ANICAL ENGINEER
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