HomeMy Public PortalAbout9658 WEDGEWOOD ST_Sewer__ ;6A642D
F-66:5 q.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER
USE or GROUP MAP
BUILDINGS-_ DISTRICT NO.
B K PG
CONTRACTOR
44
ADDRESS CONNECTION DATA
DEPTH
CITY_kl
TEL. N 0.
MANHOLE REFERENCE
9--STATE
REGISTRATION NO.
COUNTY
No._jDESCRIPTION OF WORK FEE
HOUSE Si1iER-C-0-N-NECT-1N'--G TO TYPE OF CONNECTION-,—— LENGTH FROM
Y. CURB ?P.L M.L. To P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.cln
OVERFLOW SEEPAGE PIT,DRAINFIELD P- C. NO.
EXTNCESSPOOL,DRYW ELL,M AN HOLE $ 2,00 CO. IMP, NO, JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
—1-c-6—NN-ECT ADDITIONAL BLDG.OR STATE ENCROACHIAE14T
WORK TO HOUSE SEWER fa $;..00 PERMIT NO.
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ALTER,REPAIR OR A8NOON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 00
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
--
REIMBURSEMENT-FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE APPROVALS DATE
HEREIN NAMED CON. INSPECTOR'S SIGNAI ORE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THISDAYOF 19— CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,
P17(5?
ADDRESS
-AND/OR-DRAINFIELD
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLO DRYwELLO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS.
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS R.FOUIPED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL, OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP,PIT(S) .-] CESSPOOLS 0
OF PERMITTEE i
1OHN A.LAMBIE,COUNTY ENGINEER VALIDATION ROBERT A. WOOL),CHIEF PLBG. INSPECTOR
0. CASH
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