HomeMy Public PortalAbout9542 WEDGEWOOD ST_Sewer__ u11808 10-82
rOA642r) APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 8U11_111NG
JOHN A. LAMBIE, County Engineer . E h 2
WILLIAM A. JENSEN, Supt of fluildkig v
LOCAi;iTY ,l
NEAREST
FOR APPLICANT TO FILL IN CR,-)Ss Sr.
E.S�C;�IF'ON OT N�1). "1 0
D )OWNER hei-, Wobb
J! L -
MAIL
BLOCK TRA CT ADDRESS
NO. OF BL0GS.
N 0 VV 0 N
SIZE OF
LOT CITY TEL. NO.
USE OF
BUILDINGS_ DISTRICT NG.1 GROUP' MIAP PROCESSED BY
BK P
ua
ADD RESSX1-s on CONNECTfK
ION 5A�
STATION
C,1 TY _2020
I TEL NO. G! STATION__- 1-—2- _' , --d- --____ --- 71---
0 STATE u-PPEFf-
REG I�TRAYI I ON NO 12 88- 70 0 COUNTY MANHOLE REFERENCE
NO. 13ESCRI F,-r'7ON OF WORK FEE:
TYPE OF CONNECT1PIN LENGTH FROM
1 IOUSC SEWER CONNECTING TO cu- 0 P e,� im.L.To F.L.
UBLiC SE.WER
FPT IC TANK.SEEPAGE PIT UR CIO: imp.NO. P.C.NO-
N .
PIT.S_ANlD/0R DRAINFIFLID slo.00 —------
JOB O
1 HOUSE SEVER CONNECTi-NG TO + Tm.TJNK l-ER?,.iIT NO. ROAD PERMIT NO. lJ
PR VOTE DISPOSAL SYSTEM $300
I R�N
6R—------- -A F 5 1 EA154�WFNT -CORD. FiST 0 DATE
VV 0 RK TU GUS E SEWER S 3.00 I I w
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OVERFLOW SEEPAGE PIT-DRA;NFIELD
I EXTN c_FSSPOOL,ORYWELL.,MA N HOLE@ $500
H w z
��TOR.REPAIR_Of?__A_B��NDON HOUSE Y.OR Sr.WIDENING
_ENr
SEWE�OR DISPOSALLYSI EINI _@__�53.00 E T
- SSSS .11 7 -ROACHMEN
rl 00 PERMIT NO.
lia -Idle __—____ ____ , I__ __ .
'd y
INDUSTRIAL
WASTE APF�RQVA
PER CHARGES MIT zk,
OVVFNER'S
oc) CONNECTION CHARGE FEE
AUTHORIZATION I TOTAJL� M . ! 4 ,, �
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REI.MBURSEMENTF-FE
TPACTO ToCONNECT THE ABOVE DSEINERDESCRIBED EXISTING DWELLING
I DATE I INSPECTOR'S SIGNATURE
Ic APPROVALS
'To THE 9UqL
SIGNED THIS— DAY
OWNER OR NEW HOUSE SEWER
NECT_
C
OW NER5 AGENT_____ ONNECT ADD]T IONAL
ESU I L'DING OR WORK
ADDRf-'S
IEPT 1C TANK.SEEP,PIT(5)
IHEREBY AKNOWLEDGE THAT I HAVE READ THIS APPLICATION ',NQ/OR DPAINFtELD
AND
STATE THAT THE ABOVE ISCORRECTAND AGREE TO COMPLY
"OUN Y ORDINANCE I
WITH ALL ANL STATE LAWS REGULATING
FLU i�j r3 ING AND SfWFRS. CESSPOOL. [i DRYWELL
LZ�'.. HFRF13Y CERTIFY THAT f AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
ENSCO AS REQUIRED BY LOS ANGLES COUNTY AND STATE Of: SEWAGE DISPOSAL SYSTEM
CA LIPORNIA OR THAY 1 AM THE LEGAL OWNER OF, AND INTEND TO -------
DISCONNECT Pt-UG AND
RESIDE IN, THE ABOVE DESCRIBED RES I?T)ENTIAL PROPERTY. ABANDON HOUSE SEWER jI
S�GNATUPE
13A(�:KFILL SEPTIC7ANKF3
OF PERMITI-Er,
z3 'I
FEP,PIT IS) [_ C
VALIDATION ROBERT A. WOOD
SIJPPRVIS?NG MECHANICAL ENGINEER
M.O. CASH
�i Z
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DE
PARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION HUiLDNNC -ewood
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building LOCALITY
NEAREST _
S
FOR APPLICANT TO FILL IN CROSS T.
OWNER 1J, L b
------- ab
MAIL
ADDRFSS
BLOC-
No' OF- BLD GS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
SuiLDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
ADDRES 5 CONNECTION DATA
ry o n t e TEL NO, STATION DEPTH
18STATE MANHOLE REFERENCE-' UPPER
REGISTRATIO N 0. 28-0 G OUNTY
1
10 -6F 0
NO. DESCMP�f �N OF FEE TYPE OF CONNECTION LENG
NGTH FROM
HOUSE SEWER CURB P.L. M.L-TO P.L.
5
P U B'L I G SEWER .$- .0
5�E P.C.NO ELI
EPTICTANK�SFEPAGE PIT OR jOs NO.
S,AND/OR DRAIN @ $I� 0
UOF-�-EVJ—rR C-0-NNECIING-TO §--
r_P 7 T D.00 j i
TRUNK PERMIT NO. ROAD PERMIT NO.
Uj
RIVATEDISPOSALSYSTFM $3.G0
---- -- - ---- ----- -----—--1---- --- CL.
CONNECT ADDITIONAL BLDG-73AFFIDAVIT �ffAlvNft Excmc." RECORD.INSrR.NO. DATE
-vv�J R K-
TO HOUSE SEWER @ $3,0
T RFLOW SF-FPAGE PIT,DRAIN FIELD z
6XTN..CES-POOL DRYWELL,MANHOLE $5.00
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
STATE L C'
N-ROACHMEN'r
PERMIT No.
INDUSTRIAL
WASTE APPROVAL
CHARGES
$ 2 00
OWNIKS PERMIT — ——-----—-----
0 CONNECTION CHARGE FEE
TOTAL FEE L 0 0,
AUTHORIZATION I
I HAVE AT TAH;S DATE A CONTRACT WITH THE :3E REIN NAMED CON- �EIMBUR$EMENT FEE
A. , C ONNECT THE A13OVE DESCRIBED FAIS G D-WEI-1
TH '0 'IN
TO "HE PUBLIC SEWER. APPROVALS 0 A 7 E i INSPECTOR 5 SIGNA-f'URE
SIGNED THIS-DAY OF-- 9--
OWNER OR
NEW HOUGE SEWER_
OWNERS AG1ENT-------------- CONNECT ADDITIONAL
BUILDING OR WORK
ANK,SEEP PiT(!5)
I HERVBV ACKNOWLEDGE THAT I HAVE READ !HI5 APPLICATION AND/OR DRAINFIELD
AND
STAY
E THAT THE AY30VE IS CORRVCT AND AGREE TO ,QMPLY
WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATINGPCUMBING -NO SEWERS
RS. CESSPOOL 0 ORYWELL
❑
I HEREB' [:F TI Y THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR If
'CENSED AS REQUIRED BY LOS ANC�LES COU TY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT .I AM THE LEGAL OWNS.'.OF, AND INTEND TO
RESIDE IN, THE ABOVE DF-SCR'SED RESIDE IAL OPEIRTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
5rC;NATU REOf: PERMIT!-FE/ BACKFILL SEF-
I,'FL ANKS
SEEP,Pi.(83 ❑ CESSPOOLS Fj�,
VALIDATION ROBERT A. WOOD
SUPERVISING MECHAWCAL ENGINEER
CK. M.O. CASH
q 2 JUL 4 1 0 D 7.C,
L,C, �L 4
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