HomeMy Public PortalAbout9650 WEDGEWOOD ST_Sewer__ T6A8dAPPLICATION FOR PERMIT
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E•8663 19-SS
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS - �
JOHN A. LAMBIE,COUNTY ENGINEER � - -- - --=�—
D CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY .
NEAREST
_
FOR APPLICANT TO FILL Ilii cR-OS s--
s r.
LEGAL '
DESCRIPTION LOT NO 1e' - J-'` T--- OWNER
BLOCK TRACT ^�,�' #f 1 MAIL -
F d ` -P-L.-!Yf ADDRESS --
T NO. OF BLDGS,
SIZE OF LO ,�y__ ' NOW ON LOT CITY TEL. N0.
USE OF
BUT LDING }'._4 �.: E..._ DISTRICT NO. [ GROUP MAP— I BK PG
CONTRACTOR d,,." 5 A..� ..,; _y I ` 3 ., I-_�. ,.j-- •'��
CONMCTION DATA
ADDRESS
tl✓ STATION ;' nr.; y DEPTH -
f 3
CITY TEL. a-F- .�. 6 MANHOLE REFERENCE rhJPPER�:'
STATE L J�JER
--- --' - -
REGISTRATION NO. �3:` ❑ COUNTY
_N0 ` DESCRIPTION OF WORK FEE -- --- ----- ---- ---
- - ----------- TYPE OF CONNECT 0 LENGTH FROM
,# HOUSE SEWER CONNECTING TO I -
� !
PUBLIC SEWER f� $3,50.
Y. CURB P.Lr M.L.TO P.L.
1 SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $3,00
Oi RFLOW SEEPAGE PIT DRAIN FIELD I P. C. NO.
-i EXIN ,CESSPOGL,DRYWELL,VfPPHOLE (u-$2.00 _CO. IMP. NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM - (�. $1.00 TRUNK PERMIT NO. --_ ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.OR --- --- STATE ENCROACHMENT -^- - --�-
I WORK TO HO-USE SEWER 0) $1.00 j._ PERMIT NO. _
ALTER,REPAIR OR ABAND.rN HOUSF. �
SEWER OR DISPOSAL SYSTEM __ - c{-_$1.0,0 _ r _ INDUSTRIAL
___ i-_ _ WASTE APPROVAL
CHARGES
--j----- SSSS-SSSS--
____ CONNECTION CHARGE FEE
OWNER'S PERMIT S i 00
AUTHORIZATION TOTAL FEE REIMBllRSEMEN'C FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA kEDCON- APPROVALS I DACE- {INSPECTOR'SS,GN.ACURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - - -1)
TO THE PUBLIC EWER. - NEW HOUSE SEWER �a ,• �
SIGNED THIS._ DAY OF--19-
CONNECT ADDITIONAL I
OWNER OR ZA BUILDING OR WORK
OWNERS AGENT.
"- SEP--TIC TANK.,SEEP., PIT(S)
ADDRESS- AND/OR DRAINFIELD f
—
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I
AND
SI TL TH THE ABOVE IS CORRECT AND AGREE TO COMPLY CE.SSROOLI.] DRYWELL v ! _.
WITH ALL COUNTY ORDINANCES AND _TATE LAWS -REGULATING:• ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR --- -- --- +--- ---
LICENSED AS REQUIRED BY LOS ANGELES .COUNTY AND STATE OF. DISCONNECT PLUG:AND
CA.IFORNIA OR THAT I AM -,THE LEGAL OWNER .OF THE ABOVE ABANDON HOUSE SEWER I
DESCRIBEDRESIDENTIAL PROP�RTY.. - BACKFILL SEPTIC TANKS n �`
SIGNATURE ''" i _ `' r _. _-SEER PIT(,7„L]-CESSPOOL.,aI
-- _. .
JOHN A. LAM, [E, COUNTY ENGINEER VALIDATION ___--,ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK.. Mi O. PXSH
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