HomeMy Public PortalAbout9671 WEDGEWOOD ST_Sewer__ F-663 11-55
APPLICATION. FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING
JOHN A. LAMBIE,COUNTY ENGINEER ariDREss �- r � � ✓ ,'t a '"
CASSATT C?, GRIFFIN, SUPT OF BUILDING LOCALITY
_ FOR A PLICANT TO FILL IN �c oss sr__
^LEGAL :_y ✓' !fir �'J fL a_.
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DESCRIPTION LO , OWNER
NO
MAIL
BLOCK _TRACT k _ADDRESS
NO OF BLDGS. N0.
SIZE OF LOT NOW ON LOT
USE OF - --
BUILDINGS DISTRICT NO. I- GROUP MAP
D (/ BK PG
CONTRACTORADDRESS
CONNECTION DATA _—
LL STATtON ''� ",, DEPTH ��
CFTY L 4: l L-"��' 7E ---
MANHOLE REFERENCE
/�• > C IJ STATE --- ----- r- -=---�,-•.. iw.�.':. ,i, _ LOSYER
REG ISTRAT g1 A '� ❑ COUNTY - --
NO. f DESCRIPTION OF WdRK .FEE .----------
--
HOU--SE -SEAtR---- -- - ------ TYPE OF CONNECTION.. LENGTH FROM J .r
C CONNECTING iC ' Y_ CURB P. M.L.TO P.L,
. PUBLIC SEWER @ $3.50 j- - ---- --
SEPTIC TANK,SEEPAGE PIT OR i
_PITS AND/OR DRAINFIELD _ C: $3.00'
� OYERFLOJ/SEEPAGE PiT DRAINF]ELD -- i -- ------ P, C. Np,- ? �• '/s
'r
EXTN..C-SSPO_OL,DRY1 _LL,'�AfiiiOLE r $ 2._00_ CO. IMP. NO._ JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM cE $1.00. _^ TRUNK PERMIT NO, ROAD PERMIT NO.
CONNECT O HOUSE SEWER (� $ADDITIONAL FLDG. S
G.OR._ i— --_ --- -----`--._------ ----.
'!
WORK T !.00 TATE ENCROACHMENT - -------------- -
- - ORK T-.__----------.._..------------'---- PERMIT NO.
!. AI TER,REPAIR OR ABANDON HOUSE INDUSTRIAL
5E'AER OR DISPOSAL SYSTEM cc -$1,00 _. WASTE APPROVAL
j
CHARGES
_.-_-_ !", _-- - CONNECTION CHARGE FEE -
OWNER'S PERMIT ------- ------ --
AUTHORIZATION
i��TT�p*yp� IDAT ryryRR��e+ '----{ .s --- REIMBURSEMENT FEE
la
I HAVE 6JEIAT THIS A CONITRACTALH EEE HEREIN NAMED CON APPROVALS I DATE INSPECIOR'S Si GNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLINGTO THE PUBLIC SEWER. NEW HOUSE SEWER �
SIGNED THIS_ DAY OF_—__ _ - 19I
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK -
OWNERS AGENT______ SEPTIC TANK,SEEP,PIT,'S)
FlDDR S.S AND/DR DRAINFIELD f.
I PEREBY ACKN'CIAILEDGE THAT I HAVE READ THIS APPLICATION �`—
AND STATE TH1T THE ABOVE IS CORRECT AND AGREE TO COMPLY. CESSPOOL L] DRYN'ELL❑ I
1 ITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
t LU'MBINa t,ND SEWERS, SEWAGE DISPOSAL SYSTEM ----
i 41 PE1}Y CERTIFY "CHAT F AM PROPERLY REGISTERED AND/QR DISCONNECT PLUG AND - ---
LICENSED A5 _OUIRFu BY LOS NC;LE. COUNTY AND STATE OF ABANDON HOUSE'SEWER !_ I
@ALiFO rt,4. � 4 Hn'` i ,^-,3d "fI+E LEGAL 01,1 NER OF THE ABOVE -_. . - _...
DESCRIBED REQ UE P PrOPE T!'. V .� PACK iLL SEPTIC TANKS IJ
SEEP.
PIT I CESSPOOLS ElSIGNATURE
OF PERMITI
I
JOHN A. LAMBiE, COUNTY ENGINEER VALIDATION,__, ROBERT A. WOOD. CHIEF PUBG. INSPECTOR
CK. Na
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