HomeMy Public PortalAbout9664 WEDGEWOOD ST_Sewer__ ar p.
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42D 63 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPC75Al.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONnaREs G +
JOHN A. LAMBIE, County Engineer
WILLIAM A. JEN'SEN, Supt of Building
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NEARS i
FOR APPLICANT TO FILL IN `R` ' ST - �- -- -
LECAL,
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CESCRIi"TI O(V LOT NO. OWNER � � -
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MAIL p,,r� �// yy,,{ g
BLOCK - iRA.f_T � f �.�eADDRfE S .,,f,t „ ,.xn'cwj. .+o.X.�" 'Y✓"
NO OF
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SIZE O NOW ON LOT CITY.. o,,v NO. - { - >✓' �%v'
lJ5E OF^ DISTRSCT N GROUP MAP PROCESSED BY
BUILDINGS
'CONTRACTOR
ADDRESS :'; d; s CONNECTIONDATA
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STATION rr DEPTH
CITY TEI NO
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•-'• �y STATE MANHOLE REFERENCE LOWER
REGtSTR.ATiON NO. �"'ys .,OUNTY ur
NO. I DE'.SC.RIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM '
CURB P L. M.L.TO P.S.,
T740US.E SEW'R CONN ECTI NF.a TO�— -- Y. P — ;m-
PUBLIC SEWER `ter $5.00 - —.��� - P.C.NO.
SEPTIC TANK S€EPAC f:PiT' :JR JOB NO.
Co.IMP, NO,
PITS AND/OR DRA NFIELD � $1.0.00 a�Y.
H O U sES EWE R-C.ONNE(5TI N G TO ---- -�_ TRUNK.PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ x`3.00
- _ __
_ - _— _- _
CONNECT AOD�TiON4L BLDG OR AFFtDAVl7 WAIVER C49EME:t1_T.j RECORD.IN57 L'.N0. ---DATE O
- WORK TO HOUSE SEWER - @ 53,00
i- _ S . .GE. _.-UAI
OVP FLOW EEP_AFIT, RNFIEL
t R .D
E)TN.0 E S OOL,DRYWELL MANHOLE @ $S.00 Lb.
-_. _— .._ _. HWY. OR ST.WIDENING
ALTER,REPAIR OR ABAPJDON OUSE
SEWER $3.00
OR DISPOSAL SYSTEM _.. �' � __..
_._ STATE ENCROACH b!ENT
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l I
PERMIT M0
INDUSTRIAL
YV A.STE.APPROVAL-
. _--_
CHAIR. 5
OWNER`S PERMIT2- oo ----
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE :5p vim' ----- ------ - -------- --- -
'IHAVE AT 'THIS DATE A L:ONTRACT WITH THE HEREIN NAMED CON- REIM.BU R BE.MENT-FEE
TRACTOR TO CONNECT T'HE ABOVE DESCRIBED EXISTING DWELLING -- -'T___---`- -- "--- -----
TO THE PUSLIC SEWER- APPAO V ALS 1 DATE I INSPECTORS SIGNATURE.
SIGNED THIS DAY —L-
OWNER OR NEW HOUSE SEWER
OWNERS CONNECT ADOI T IONAL
BUILD NG OR WORK
ADDRE.,.S SEPTIC TANK,SEEP;PIT(S)
�I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND:'OR DRAINFFIELD I
AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY --.-.-----------
W]TH .ALL COUNT'{ ORDINANCc:3 AND STATE LAWS REGULATING --I ���-----_--__-
PLUMBING AND SEWER?.- CESSPOOL DRY'WELL [�
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS R.EQUIRFO BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM �
CA-IFORNIA OR THAT I AM THE LEGAL OWNER OF', AND INTEND 7.0 -
OtSCDNNECT PLUG AND
SIDE IN, THE A.SOVF DESCRIBED RESIDENTIAL, PROPERTY. ABANDON HOUSE SEWER
SIGNATURE j f EIACIFILL SEPTIC TANKS
OF PERMITTEE Qf
SEEI>,PIT(:S) CESSPOOLS []
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
! CK. i M.O. CASH
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3&E-66S 99.53 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING -g
JOHN A. LAMBIE, COUNTY ENGINEER - _ ADDRESS_ " a � ,y='i,'Y,L✓
CASSATT 1O. GRIFFIN, SUPT of BUILDING -
LOCALITY
FOR APPLICANT TO FILL IN N£AR£5T
LEGAL — ---e—
DESCRIPTION -LOT NO. � OWNER
BLOCK' TRACT �. MAIL
I s. E, ADDRESS_________
tt 2, _ _ADDR€SS_ _-_-- _NO.OF BLDGS. CITY TEL. NO.
SIZE OF' LOT OW;� ON LOT -
USE OFJ� ---_-----
iiUILD1NGS DISTRICT NO. GROUP - i MAP
_✓ BK PC
CONTRACTOR
4.
ADDRESS
y } CONNECTION DATA -r
y'rl fe' a+�L jl�� ------ - - -
"•` STATION ,v ✓' DEPTH
yr`
CITY � � Iv
` TEL. --� '"--_, ;i_�'- _LL
---- MANHOLE REFERENCE fy
.,Y.yy � �✓9,ri,:..,r st6 L STATE LO
_ _.._ _✓-t2--_ �'-i .f r,..-.- y� jER -
R£GISTRATION NO.
NO, j DESCRIPTION OF WORK FEE --
--- ------ - -- ---- TYPE OF CONNECTION - LENGTH FROM
HOUSE SEWER CONNECTING 0 j Y, CURB '�' LC M.L.TO P.L.
a
FU}3L1 C_SEWER_ � $.3.56 �' - _ -__--- ---- -r+, „%--- --- --�'� -'-
SEPTIC TANK S�EPAC£PIT QR
-
rPiTS AND/OR DRAINFIELD C $3.00
L.—.""_-T----
OVERFLOW SEE?AGE Ptl,DRAINFIELD I P. C. NO,. ;' I
EXTN„CESSPOOL,DRYWELL,MAN 90LE ; $2.001 CO. IMP NO.-,------ i0B NQ. ---
j HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM r4 5.1.00 TRUNK PERMIT NO ROAD PERMIT NO.
-'VCONNECT ADDITIONAL BLDG,OR - STATE ENCROACHMENT
WORK TO HOUSE SEWER (u $1.00 . .PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE --- --- --.�---_---"---------
-------- --
SEWER OR DISPOSAL SYSTEM (rl 1,00 INDUSTRIAL
.____.. ---- WASTE APPROVAL
----�-'---'--- --------- CHARGES
--___-- CONNECTION CHARGE FEE. .
OWNER'S PERMIT $ --1 00 - -- _ __-__. --------
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATEINSPECTO R'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
TO THE PUBLIC SEWER. NEW HOUSE SEWER -
SIGNED THIS— AS1F 19_-- — _ ----- _---- -_
�+ CONNECT ADDITIONAL :
OWNER OR """yL- �✓ BUILDING OR WORK__ _ --
OWNERS AGENT -- SEPTIC TANK,SEEP,PIT($)
ANWO.R DRAINFIELD ._-----.--._-----
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL(] DRYWELL❑ - -
AND SPATE THAT THE ABOVE IS CORRECT ANDAGREE 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND�.
CALIFORNIAA OR THAT I AM IE -.LEGAL OWNERER F THE -BONE ABANDON HOUSE SEWER
— -- ---- --1- ------
DESCRIBED RES7,DE PRO BACKFILL SEPTIC TANKS 0'” m
SEEP.PIT(S) 1-3CESSPOOLSL.
SIGNATURE '-..�,.._�- ,.: �C<' - -` '- ,. --_.._ --- -- - —+---__—.------
OF PERMITTEE_
IOHN A. LAMBIE OUNTY ENGINEER ,,....."VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
CASH �'
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