HomeMy Public PortalAbout9552 WEDGEWOOD ST_Sewer__ TlLpl-A] �211:iliy
E808 10-62
76A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
i
JOHN A. LAMBIE, County Engineer ADDRESS d e-wood
WILLIAM A. JENSEN, Sup-t of Building
LOCALITY
NEAREST
7*�
FOR APPLICANT TO FILL IN CROSS
L 011 NO.
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OWNER
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NO, OF BLD GS.
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-SIZE OFLOT ID GN LOT CITY TEL. NO.
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D15TRICT NO. GROUP MAP PROCESSED BY
BUILDINGS
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CONTRACTOR valwf�',Q�
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CONNECTION DATA
_ADDRESS Is � --- ----1------
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CITY El !L;lontc TEL NO!lxl ) -'�-020 STATION DEPTH
MANHOLE FEFP:RENCE
10 STATE LOWER
NO. COUNTY
CL
NO. 1 DF RIFTHON OF 1--bRk
TYPE Or CONNECTION LENGTH FROM 0
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0 P.L. M.L.TO P�L.
PUBLIC SEWER --------
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P.C.NO,
p-No_
PITS AND/OR DRAINFIELD s10.00 Co.ImJOB NO. 0
HO-,JS F.SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $s.OG I r)
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C ONN C CT ADDiTJONAL BLDG.OR AFFIDAVIT IN-ST-R—NO-7-1 - D-A-Tr----
WORKTO HOUSE SEWER _____ @ $3,00 1
OVERFLC OW S!:EPAUr Pit.GRAINFIELD z
E.X-T 114.,CESPOOL-,DRYVVEL-L,,MANHOLE @ $5,00 HWY. OR ST.WIDENING
ALTER
L
SEWER OR Di:SPOSAL SYSTEM @ $jOO
ROACH
-NC' -ENT
C
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNEF17S--7-aliml-T CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE
I HAVE AT 11-111 DATE A CONTRACT WIrIi
R THE HEREIN NAMED CON-
- A CTOR TO CONNECT THE ABOVE, DESCRISED EXISTING DWELLING
To THE PUBLIC SEWER. APPROVALS -[I INSPECTOR'S SIG NATU RE
G;GNED THISDAY Or:-- --- --------- t -- ------.
OWNER OR NEW HOUSE SEWER
OWNERS AGF.NT------ f
CONNECT ADrTrIONAL
94 !1_OIFdC
UILOING OR WORK
A 0 0 P�7.S-q
sLpTic I-ANK,SEEP PIT(n)
I N2.RYMY ACKNOWL-EDGE THAT I HAVE READ THIS APPLICATION ANDS CR ORAINY iELO
AND
A
ST TE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
W,rHALL CoijNTY ()RO INANCES AND STATE LAWS REGULATING
�j
PL tja ING AND SEWERS. CESSPOOL ❑ DRYWELL.
I HEREBY CERIFFY THAT I AM. PROPERLY REGISTERED AND.OR ALTLN REPAIR.R SEWER OR
t_j C�FINSE I� AS REQUIRED 13Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
,7 E R,�b F -0 _ -____ _-- - -
-ALIFORNIA OR THAT I AM THE LEGAL OWN I AND INTEND D I�C�ONNrCT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RFSIGEN-94L P.FfOPrRTY. ABANDON HQUrE SEWER
SIGNATURE
EE BACKFILL SEPTIC
SEEP,FIT(S) Ll CESSPOOLS
"VALIDATION ROBERT A. WOOD
SUPERVISING MECHAP41CAL ENGINEER
O. CASH
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