HomeMy Public PortalAbout9644 WEDGEWOOD ST_Sewer__ sA -SC
E—BE3 3.59 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Depaximent of County Engineer
County of Los Angeles BUII.DrNG
WM.J. FOX.COUNTY ENGINEER ADGRESS— ,
CASSATT D.GRIFFIN, SUP'TOF 1311LOIN6 `LOCALITY
FOR APPLICANT T® FILL IN NEAREST J
LEGAL
DESCRIPTION LOT NO. ® OWNER �d _:_4..�
fir' ,.
ION s" s' m
BLOCK TRACTMAIL
-3 3 --ADDRESS
N0. OF BLDG$,
SIZE OF LOT NOW ON LOT —,--_ CITY TEL, NO.
USE OF — It i
DISTRICT NO. GROUP MAP
SK PG
CCNTRACTOR -. ,�••__ 'y _ I ___ .P4,,+
CONNECTION DATA
CITY " I'LL. N;4
STATION _ DEPTH 3
❑ STATE MANHOLE REFERENCE
REGISTRATION NO, ` - ❑ COUNTY
NO. DF_SCRIPTION OF WORK FEE
TYPE OF—CO—NNECTIO — LENGTH FROM SEWER CONNECTING TO L. TO PL Bn $ CURB P.L. M. �_,---.
~'—
------
HOUSESEWER CONNECTING TOY-
PRiyATE DISPOSAL SYSTEM 1.00 - -----" -------------------
-- - —
GCMNECO POUSEONAL BLGG, OR ^_ _ _ P C N,O
ADD
>4 J"-° "d--"---
C�T; 70 POUSE SEWER 1.09 CO. [M�. NO. vZ'
ALTER OR REPAIR ,'ISTINC _
SEWER OR DISPOSAL SYS'+EM1.00 TRUNK PERMIT NO, ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER - -- _f�— —Y_ STATE ENCROACHMEN'C -------'- --- —
ANGOR DG FO AL SYSTEM LO._ PERMIT NO.
-
SEPTIC TANr SEEPAGE PI'f OR jYff'
•PLTD�OR DAA1d�i,LD I INDUSTRIAL
— -- WASTE APPROVAL
CESSPOOL. DRYWELL
SPECIAL CONDITIONS ONLY 200 CHARGES
w"' -- '—�--'-- - CONNECTION CHARGE E FEE
OWNER'S PERMI - � 1 00 -- - —--
AUTHOEIZATION TO.1E FEE � � � �=�� ReFIIfiBURSEMENT EF_
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON— rygp y�
TRACTOR TO CONNECT '.HE ABOVE DESCRIBED EXISTING DUELLING APPROVALS � DA7'EIN$r--CTOR'S SIGNATURE
TC THE PUBLIC SEWER -•- --_ ..__.__-- _-- -- _ .._ __—. _
SIGNED TrflS -DAY OF 1s.. NEW ROUGE SEWER — _µ--
OWNFR OR �^ �✓ _ CONNECT ADDITIONAL
OWNERS AGENT sG AC,' BUILDING OR WORK
SEPTIC.TANK,SEEP, PIT(S)
_,AND/OR DRAINFIE_LD
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYINELL M -- —
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE, TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR EWER OR µ
PLL 4 ING AND SEWERS. SEWAGE DISPOSAL$-37£41
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ^DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ABANDON i2US SEWER
DES IBRD RESIDENTIAL PROP TY.
/ BACKFILLSEPTIC TANKS
SEEP PITS) ❑ CESSPOOLS
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PMSG. INSPECTOR
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