HomeMy Public PortalAbout9546 WEDGEWOOD ST_Sewer__ 4
CE81,8 10-62
,6A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
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JOHN A. LAMBIE, County Engineer ADDRESS qwod
WILLIAM A. JENSEN, Supt of Building L,,OCA.LITYii
NEAREST
FOR APPLICANT TO FILL IN ROSS T
LEGAL -------I--
DPSC LOT NC 11 E R Lew We bb
BIL CK TRACT MAIL
a b ADDRESS
NO. OF BL.DGS.
SIZE OF LOT NOW ON Lor C�Ty TEL. NO.
USE OF
Y
DISTRICT NO. GROUP MAP PROCESSED B
BK PG
Sei,,,er Service
COIT-ACT-R Deal�-
ADDRESS �aa3a Rd. —CONNECTION DATA.
CITY 0DEPTH
_LI'L_jh�j Qn_t_e TEL NO. ��STAT I ON
STATE
STRAT(ON MANHOLE REFERENCE
REGI 1�0
No r----bFSZRIPTION OF �V RK F5E TYPE OF CONNECTION LENGTH FROM
1 -1 ---------T- CL
I HOUSE SEWER CONNECTING TO tc)
Y
.�URB'� M.L.TO PAL,
PUBLIC SEWER @ $$.0,
0
P .NO
@
P .TANK CO. IMP. NO. JOB NO.
_r!'S ANO OR PRAINFfELD $1000
I HOUSE TRUNK PERMIT NO. ROAD PERMIT NO. OJ
PRIVATE DISPOSAL SYSTEM C $3.00
R
C 0 E,CTADD-,T[-ONA"LBL-D-G, OR AFF F16A GTR-N,6--
WORK TO HOUSE SrWER 00 1LU
EXTN.,CESSF'OOL,DRYWELL,MAtiHOLE @ $B.00 z
At-TEFZ REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
-EwrR o�l DISPOSAL SYSTEM S3,00
STATE ENCROACHMENT
('ERM I N 0.
INOUSIRiAL
WASTE APPRC,'1AL
OVIMR'S 00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WIrH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTO+ To C ONNECL
T THE ABOVE DESCRIBED EXISTING DWEL)NG
TO THE PUBLIC SEWER. APPROVALS DATE i MSP ECTO WS 91 G N A I URE
SIGNED THIS---DAY
OWNER OR NEW HOUSE SEWER
OWNERS C ADO '--N-A--L-
ONNECT n 10
BUILDING OR W OR
ADDRESS K-,-------
SEPTIC TANK.SEEP,PtT(S)
IHCREBY A7KNOWLZDGr THATI HAVE REAL) THIS APPLICATiON AND/OR DRAINFiELE)
AN DSTATE THAT THE ABOVE IS CORRECT
0 7 4RECT AND AGREE TO COMPLY
WITH
ALL COUNTY ORDINANCES A D STATE LAWS RFGULAT;MG
PLUM81NG AND SEWERS. CESSPOOL D DRYINE-IL
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND!OR ALTER,REPAIR,SEWER OR
I I
LICENSED AS REQUIRED BY L 05 AW,LES COUNTY AND SrArE OF SEWAGE DISPOSAL SY$T EM
CAI-iFORNEA OR THAT I AM THE LEGAL OWNEIR OF, AND INTEND TO
RD DISCONNECT PLUG AND
_ I E 'ESIL)Fe, ,PRO'PERT'Y.S DE IN. THE ABOVE DESCRIBED 1, A ABANDON-11 OUSESEWER
SIC IjRF
,NAT
01' PERMITTEE_ BACKFILL Tti.
TANKS
SEEP,PTT(S) '—I CESSPOO;-S
ROBERT A. WOOD
CK. M-0 CASH SUPERVISING MECHANICAL ENGINEER
76A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS -7,
JOHN A. LAMBIE. County Engineer -----
--
WILLIAM A. JENSEN, Supt of Building
LOCALITY
moll,
BUILDING
ROS ST
FOR APPLICANT TO FILL IN
2�
LY CL
Dr5CHIV iON L.2T NO. OWNER
MAil_
Bi-OCK TRACT ADDR-IS-1
BLDGS.
SIZE 'IF LOT N01V ON LO' CITY TEL. NO,
USE OF
a UILD- INGSLI DISTP[CTN GROUP MAP ROCESSED By
BK PG
_CCINTACTOR
ADDRESS CONNECTION DATA
'ITATI.11 DEPTH
CLTy TEL.
0 STATE
REIFRATiON NO. 7 COUNTY -MANHOLE REFERENCE
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0
NO D ES C R I PT 10 N OF WORK FEE -0 __c0 N I,I E c 7.1 9N LENGTH FROM
HO rSt SE W
�R CONNECTING TO c Uq a M L.'COP L.
PUB1_1CSEWER P .NO.
SEPTIC TANK,SEEPAGE PIT OR ix
FICTS AP4L-,/OR DRAINFIELD SIU.00 CO, IMF.NO. JOB No. 0
HOUSE SEWER CONNECTING TO
TqUNK PERMIT NO. ROAD PERMIT NO.
PA-Tr D;SPOSAL SYSTEM $3.00
WA YEN E-L.Elly DA E
CoNNE:CT ACIDITIONAL BL.DG.OR NO
WORK TO HC- L SEWER $3.00
OVERFLOW SEEPAGE PIT,DRAiNFIELD z
1 F.X-rq.,CESSPOIDI-.DRYWELL.MANFiC)LE $5.00
&� —_-_____ HWY.OR ST.WIDENING
SEWER Op DiSP05AL SYSTEM. $3 00 ------
STATE ENCROACHMENT
PERMIT NO.
INDUS'
WASTE APPROVAL
CHARGES
OWNER PERMIT
_z
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE: A CON'.RACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
To THE P UU 1,IC SEWER. APPROVALS I DATE INS,--F-TOR'S SIGNATURE
SIGNED PHIS DAY
OWNER OR NEW HOUSE SEWER
OWNERS AGENT—_. CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS--._.
------ E5z�pi;c I-ANK,SCEP,PIT(S)
1 HER EBY ACKNOWLIEDGE THAT 1 HAVE RAD THIS APPLI'�ATION AND/OR 0,_RAINFIELD
AND STATZ THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY
WITH COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWER`S. CESSPOOL DRYWELL
N, 1111
CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LI "NbED AS REQUIRED BY ANGLES USE COUNTY AND TATOF SEWAGE DISPOSAL SYSTEM
CAL.IFQRi A —THAT, I AM THE F, INT:
ENO OWNER OAND INTNO TO
RESIDE
I N, THE ABOVE DESCRi BE[) RE S(DENTIAL PROPERTY.
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIGNATURE 1 0 � , I ✓
PTiC fANKS
Tfs) D FFSSPO(>LS Ejj
BACKFiLL Sr
OF SEEP,P,
-VALIDATION ROBERT A. WOOD
CK.�/ M.D. CASH SUPERVISING MECHANICAL ENGINEER
Vis,
L 1 .1. 4 JUL 14 11. 1 D �20 5.J
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