HomeMy Public PortalAbout9668 WEDGEWOOD ST_Sewer__ S&E-60
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APPLICATION FOR PERMIT ],
-6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Loa Angeles BUILDING :� ✓`� yf A _
WIY1.J. FOX, COUNTY ENGINEERADDRESS
C:ASSATT D. GRIFFIN,SUPT oe Hu1LnING LOCALITY r -
7ttx� q 77iiW7 NEAREST ¢,� Ave T
FOR AL"CI.L�.°Lx1riT �� FILL IN CROSS ST. '�C°`% .( '/1f' &'�.•`M'. i' e
LEGAL
,DESCR[PTION L.OT NO. OWNtk..
BLOCK TRACT ,,,'
NO. OF BLDGS. _
Si:7E OF LOT _ NOW ON LOT CITY
USE of --
BUILDINGS DISTRICT N0. i! GROUP - MAP
CONTR;,CTOR - ,�, g .--- ," ,Y--v o --�P � SK PG
ADDRESS a 34142 CONNECTION DATA
CITY TEL. N0. �* - p - .. STATION DEPTH °
_ [] STATE '- ANHOLE REFERENCE -�-'�—
REGISTRATION NO. +/� L--Ct3f1F+`f'Y •,1UP, =_ LOQ+.TER •
--' TYPE OF CONNECT LENGTH. FROM - -
No. f DESCRIPTION OF WORK
FEE _X'�___—_tee_-�'` P.L.,tP _bS.L �!0 P.L.
I
HOUSE SEWER CONNF.;TING TO p-..
_,i_„!`PUBLfC SEWER ----Cal S 3.50_�_.y
_H_,CUSE SEWER CON NECZING 70 _
--_j FRIVATL DISPOSAL SYSTEM. _ 1.00_
i CONNECT ADDITIONAL BLDG. OR� c
I C.O. IAtP. NO.
'N� S'C. N
ORK TO HOUSE SEWER_ I.OD i I P
ALTER OR RF?AIR 6 Ss`ING-� --� -- - -. ��.� —�
SEWER OR DISPOSAL SYSTEM 1.00 ( i TRUNK PERMIT NO. ROAD PERMIT NO,
D;SCONNECT AND ADA DON SEWER STA NCROACHMENT
i -OSAL SYSTEM _ PERMIT SEPTIC-TANK, SEEPAGE PIT OR - -- _ .y-.-._.'-.—.---------
P T`;ANL/OR DRAINFIELD 2.00 j I` INDUSTRIAL
WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.0.0-I����^. _yy'r''�::CHdRGES
PERMIT j - CON3; N CHARGE FEE -
Oi3VI °S _ _ 1 j 00 -- -- —AUTHORIZATION TOTAL FEE --i 6 REIMBURSrMENT_FEE
1 PAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON. APPROVALS t� �+
TRACTOR TO CONNECT THE ABOVE DES IDED EXISTING DWELLING APPROVALS :DATE 1NSPEETOR'S SIGNATURE
TO THE PUBLIC SEWER r'C�- --- �--
NEW HOUSE SEWER
SIGNED TEAS DAY 0F2
0:'.'"NER OR f" CONNECT ADDITIONAL --- — -
OWNFRS AGENT � BUILDING OR YORK
ADDRESS._. c.�,�3 d WF-I'4 i���� 4 SEPTIC TANK SEEP, PET(S)
_AND,,OR DRAINrIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELLC]
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COIMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS - SEWAGE DISPOSAL.SYSTEM
' HEREBY CrRTIFY THAT I AM PROPERLY REGISTERED AND/OR '--_-- —` - -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALiFCRNIA OR THAT AIV; THE LEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER _
DESCRIBED RrSIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS L7
« SEEP.PITS) 0 CESSPOOLS
SIGNaTUPF
OF PERMITTr_E .' � f —_
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION
BY BY ._
DEPUTY DEPUTY
n
By BY
0 DEPUTY s_�ee .I s� taX