HomeMy Public PortalAbout9536 WEDGEWOOD ST_Sewer__ DEPART"M(ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
FOR APPLICANT TO FILL.-IN LOCALITY
BUILDING — NEAREST
ADDRESS. f - of 11 ° NEARE ST. C.y
LOCALITY `f e" S DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A / S
CROSS ST.
RECEIVED BY Ready for Inspection DAT�E^ISSUED
OWNERMAIL
_ 7SrE
ADDRESS - USE ZONE OCCUPANCY MAP
__ BK PG
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CITY TEL.NO.i r�fev ,y.-...,.,,......
CONTRACTOR --- ---- - CO.IMP.NO. zx
ADDRESS
CITY TEL.NO.
STATE
REGISTRATION NO. R-CUN`TY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO.
-- — FEAR MIT NO.
BLOCK TRACT INDt
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECT! HARGE FEE
NO. DESCRIPTION OF WORK; FEE"
-- -- ---- REIMBURSEM NT FE
HOUSE SEWER CONNECTING TO (�
PUBLIC SEWER @ s 3.50 RECEIPTNIVM
ATE (BY
HOUSE SEWER CONNECTING TO
PRfVATEDISPOSAL SYSTEM 1,00
CONNECT ADDITIONAL BLDG.OR
jWORK TO HOUSE SEWER 1,00 EXCEPTION RECORD
ALTER OR REPAIR EXISTING NO- { DATE
SEWER OR DISPOSAL SYSTEM 1.00 I f
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITSAND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 L'�1 94A UPPER EFERENCE
PE QbSWJ&&ECTION LENGTH FROM
OWNERS PERMIT ; I 00
Y. CURB P.L. M.L.TO P.L. �l J
_
AUTHORIZATION I TOTAL FEE ✓
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS------- -----------DAY OF... -,19 .... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _-, _..----._.. BUILDING OR WORK
y,�. _ SEPTIC TANK,SEEP.PIT(S)
ADDRESS —f
:...` '-'-- --_-` ._- •--... AND/OR DRAtNFI£LD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO NOMPLY 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
AHD/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)� CESSPOOLS E]
OF PERMIT ...............' ....a :
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I
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