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HomeMy Public PortalAbout9543 WEDGEWOOD ST_Sewer__ .mEpAxTDIE*T-OF COIINW ENGINEER ��• SEWER-SEWAGE-DISPOSAL ' -DIVISION OF BUILDING AND SAFETY ; PERMIT APPLICATION 1 COUNTY OF LOS ANGELES _ WILLIAM J. FOX, COUNTY ENGINEER �: BUILDING We:t, +� `- �•I ADDRESS 9cJ .7 bar Vif "�r, FOR APPLICANT TO FILL IN LOCALITY BUILDING. y�� NEAREST ADDRESS -9546, 11® ®WOQd. ` CROSS ST. OI (' LOCALITY zAhlYi' DISTRICT NO. SERIAL N0. PERMIT NO. �� ; w � -S NEAREST �q�� M J CROSS ST. br9iLN+Y Vi RECEIVED BY Ready for Inspection DATE ISSUED OWNER S s A: RAahnIL •II � Cfl(�x�I 1l,or [Sir�'(�� ADDRESS k ••UNE. OCCUPANCY Bit MAP PG TEL:NO. CONTRACTOR ®® 8Ste� g � CO-IMP.NO. ADDRESS 6522. Loden West Aln�-- JOB NO. CITY TELAO.• At Marg TRUNK PERMIT NO. •-® �..$STATE REGISTRATION NO. ,74 - ❑'COUNTY: ROAD PERMIT NO. LEGAL /�,Q ��� DESCRIPTION LOT NO.J_2' 8gl 'M' Vim' PERMIT NO.ENCROACHMENT_____, BLOCK TRACT INDUSTRIAL WASTE APPROVAL 812E OF LOT 1 NOW ON{{,,pp LOTB� li ` CHARGES USE OF r BUILDINGS ' ®ILTt'yn— - CONNECTION RGE FEE NO. DESCRIPTION OF WORK FEE J:' HOUSE SEWER CONNECTING TO QQ _ REIMBURSEMENT FEE PUBLICBEWER 0� $ 3.50' c$ � �+' RECEIPT NO. I BY HOUSE SEWER CONNECTING TO " PRIVATE DISPOSAL SYSTEM 1.00 L. CONNECT ADDITIONAL BLDG.OR " EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING { NO. I DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 1 -DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 ' !NATION .. I DEPTH CESSPOOL-DRYWELL (, SPECIAL CONDITIONS ONLY 2.00 r. -�d/�(M/LNfUlt 'R€ PPER!FERENCE yj TYPECTi LENGTH FROM OWNERS PERMIT ; 1 00 CURB M.L.TO P.L. AUTHORIZATION I TOTAL'FEE jam© I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED, CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INS PECTO *SIGNATURE, _e DATE DWELLING TO THE PUBLIC SEWER ' SIGNED THIS._.�_�'._DAY OF...._ aa' 19 NEW HOUSE SEWER.. OWNER- •OR ( y)� �� /'Ol!�J r' CONNECT ADDITIONAL OWNERS .AGENT.. -jA � ^.nA.�.-'6'.�-�f+ P_�•� �' BUILDING ORWORK V" Y vG v - . �r rte.. • - u.�y r SEPTIC TANK,SEEP.PIT(8) ' ADDRESS. .:......-....................-........-•--r......-........-. AND/OR DRAINFIELD P HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS-APPLIi CESSPOOL❑ DRYWELL CATION AND 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. 1r SEWAGE DISPOSAL SYSTEM 1 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 I AM'THE LEGAL OWN= ER OF THE ABOVE DESCRIBED R E TIAL PROPERTY. BACKFILLSEPTIC TANKS � SIGNATURE SEEP.PIT(S) CESSPOOLS' OF PERMITTE - -•• � '^" r("�� • 76AG42A 603 7/53 r