HomeMy Public PortalAbout9646 WEDGEWOOD ST_Sewer__ 76^6420 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
W .J. FOX. COUNTY ENGINEER ADDRESS
CASSATT 0.GRIFFIN, SUPT OF SUILDIlNG -LOCALITY
FOR APPLICANT TO FILL IN NEAREST
LEGAL
DESCRIPTION LOT NO. _ OWNER
----- .. _
BLOCK TRACT+� r3 3 MAIL
_ADDRESS , ,_--_
-^ ANO. OF BLDGS.
LOT -� CITY TEL..NO. u-
USE OF ,.
BUILDINGS Va'� '`�' DISTRICT N0. i CROUP � MAP
BK, PG
CONTRACTOR
ADDRL� CONNECTION DATA
,rte s�-ry� STATION �T'" DEPTH
_CITY > TEL. NO
STATE MANHOLE REFERENCE "' '1 q;, ,p✓"-� �T'r'=''�
REGISTRATION N0. + 7 !� COUNTY --___—.. ,-_„�__,;�g LOV ER _
--�NO. DESCRIPTION OF WORK FEE - 'TYPE OF CONNECT O 1 , LENGTH
PLBLIC SEVIER
SEW CONNECTING TO. 5 3.50 . I Y C
(� _70
HOUSE P L �
HOUSE SEWER CONNECTING TO
___PRIVATE D SPOSAL SYSTEM__ f 00 __,-Y ----- ------ - ---- -------
CONAECT ADDITIONAL BLDG. pR --- Y P C. NO °
WORK TO 1,00 E !
E HOUSSEWER CO. MP. NO_ f
_..._ - - _�__.�:_- _ ___',dam_✓-' .-.------
As -f P. OR REPAIRTRU!K PERMIT NO ROAD PERMIT NO.
SWER OR DISPOSAL
SYSTEM.
EE.M_ l 06 � -.--. ---- _ ----!__-------
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND (1R DISPOSAL SYSTEM. _ 1.00 PERMIT NO.
- SEF iC TRNY SEEPAGE PIT OR _ - --.,.- --- -- -- --'-------
YITS_ANO/02 DRAIN. I "�ELD _j GO 1NDUSTP,IAL
CESSPOOL DRYWELL
WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 0_0 CHARGES
CONNECTIONCHAP"E FEE
OWNER'S PERMIT $ � I� Op
AUTHORIZATION TOTAL FEE i r, RElrneuREM.ENT FEE
--
I HAVE 7H'S DATE CONTRACTED V41TIl THE P'RE IN NAMED CON-
T
7O SON NECT THv' ABOVE UF.SCRIBEll EXISTING DWrLL1NG APPROVALS DATE �iNSPECTOR'S SIGNATURE
YO THE PUNLICSEWER '-----__-
NEW HOUSE SEWER -- _
SIGNED THIS _—DAY OF— .TJ__
CONNECT ADDITIONAL
OWNER OR -..t'�. BUILDING OR WORK
OWNERS AGENT_ 'd/
B- -- ---- _ -- ._
SEPTIC TANK,SCEP, PIT(S)
AND/OR DRAI_NFIELD - -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL DRYWELL i!
AND STATE THAT THE ABOVE !S CORRECT AICD AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTFM fff
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OP,
LICENSED AS REQUIRED BY LOS AIIULES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR,,'THAT I AM ? LEGAL OW N'� OF THE A VE ABANDON HOUSE SE+YER.� �_
DESCR .RE'' DENTIAL PROP TY. BACKFILL SEPTIC TANKS
5E l SEEP. PIT(S) LSI CESSPOOLS -
WILLIAM J.F COUNTY ENGINEER AIALIDATION R.A.WOOD. CHIEF PLaG. INSPECTOR
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