HomeMy Public PortalAbout9659 WEDGEWOOD ST_Sewer__ �
SaJE-6E3 3.55 APPLICATION FOR PERMIT
S&E•5 _. 1.
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of-County Engineer
County of Los Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN, SUP'T OF BUILDING LOCALITY
_ FOR FLIC4NT O FILL N,.,
NEAREST
LEGAL -
OESCkIPTION LOT NO. C�1}`" ,✓ OWNER b "
BLOCK T`RACTIb 'w'"a;•".s"^".^'its'W-.,z'�.G,jL� - .�.`' MAIL
ADDRi_SS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE OF —
BUlLD1NGS _ _ DISTRICT NO. t GROUP MAP
-- Jam"------- BK PG
CONTRACTOR ` , —
ADDRESS -- CONNECTION DATA—
. CITY `. NO.
STA TION ` �'� j DEPTH ✓
J' ✓
-.s. ❑ STATc MANHOLE REFERENCEUPPERS= Ai ..._.
REGISTRATION N0._ g{ ❑ COUNTY
NO, DESCRIPTION OF WORK FEE
MOUSE SEWER CONNECTING 70_-� c. TYPE OF CONNECT fj LENGTH
= P L t L. 70 P L. _
PU3L1C SEWER (t�-$ 3.50 'a - -- - --
+ HOUSE SEWER CONNECTING TO
—
1 PR VA7E DISPOSAL SYSTEM 1.00 --
ICONNECT ADDITIONAL BLDG. OR P C NO. 4 />
V OR}i TO HOUSESEWER 1.001 '� Z✓ _Co.-_imp._NO. �-""'�- JO0 NO. 4r,
LALTER OR REPAIR EXISTING I
it SEW-R dR DISPOSAL SYSTEM 1.00 "FSK PERMIT h0 ROAD PERMIT NO.
V!SCONNECT AND ABANDON SEWER �.
1 STATE P1CROACHMENT
AND/ORDISPOSALSYSTEPR
1.00 STATE PERMIT P10, V
r•.
SI-'TIG TANK,SEEPAGE PIT OR
PITS AND/OR DRAINF[ELD `, .COINDUSTRIAL WASTE APPROVAL
CESSPGOL-DRYW E.LL
SPECIAL CONDITIONS ONLY 2.00 -- -^ ----- V_CHAR_ES --- —i---
-- y .
PERMIT S 1 OG CONNECTION RGE FEEOWNEWS
AUTHORIZATIONTt�TAL FEE ���� REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN 14AMED CON-
TRACTOR
OPi-TRA TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE' 1NSPECTOR'SSIGNATURE
TO TIHE PUBLIC SEWER -
NEW HOUSE SEWER
SIGNED THIS DA 1. 19,31 ___ I---- --- -
OWNER OR C014NECT ADDITIONAL - _-
OWNERS AGE/NT� BUILDING OR WORK
ADDRESS-2
ds' "i d '; SEPTIC TANK,SEEP, PIT(S)
.Y .d ' ANE/OR_DRAISFIELD__
I
Hp
TEBY ACKNOWLEDGE THAT 1 HAVE REA (THIS APPLICATION CESSPOOL i7-DRYVd£LL.i� - -- v—
AND STATE THAT THE A60'VY I5 CORREC"I' AN T AGREE TO C01APLY -_____.,__ -____•�. _.,_�__- -___,_
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING ALTER, REPAIR,SEINER OR
PLUMBING AND SEWERS, _SEWAGE DISPOSAL SYSTEM
I HEREBY 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 HOUSE SEWER, _-
DESCRIBED RESID
ENT . BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) ❑ CESSPOOLS
'
SIGNATURE !"y �___.--.
OF PERMITTE t.+gG.9V
WILLIAM J. COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF PLBG. INSPECTOR