HomeMy Public PortalAbout9672 WEDGEWOOD ST_Sewer__ &£ �3 12-54
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3 Fk APPLICATION FOR PERMIT
1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING Z r
.J. FOX, COUNTYt�NGINEer ADDRESS
\NtYI 'y/,'�
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APYaI.IGAN'F TO FILL cso s s'T_ .,I � ; .r. ✓,�.-t.
LEGAL —
DESCRIPT[ON LOT NOOWNER
BLOCK TRACT 111 'MAIL
N0. OF BLDGS.
SIZE OF LUT. NOW ON LOT ` "� ,';;, .
USE OF
BUILDIN GS�. .7'. ,�, „ r` e-= - -
DISTPIC7 No. � GROUP 4 MAP
SK PG
CONTRACTOR
ADORE SS d *F 3' i s y � , tl. CONNECTION DATA
aCITY TEL.
STATION DEPTH
y
,,ter {� STATE *- MANHOLE :REriC `'-
-REGISTRATION NO. /� '" y 'y� G_e&w+*y_- _ UPP y LO_NEi
TYPE OF CONNEC -4, LEhrT t
NO. DESCRIPTION OF 'YORK FEE - Y• CURB P.L.'•' M.L_TO
IT HOUSE SEWER CONNECT!-NO TO
PUBLIC SEWER $ 3.50^
14OU5E SEWER CONNECTING TO -
PR!VATE DISPOSAL SYSTEM 1 60 t
CONNECT ADDITIONAL BLDG. OR CO. IMP.N0, r,7
I WORK TO HOUSE SEWER 1.00 I -•` ' a'
ALTER OP REPAIR ERI TYNG
tLW}R OR D POSA� 51 STEM - 1-00
TRUNK PERMIT NO. ROAD PERMIT NO.
DIS..ONNEC1 iAID AF_A_ "ON SEWER
AI`DOOR DISPOSAL SYS 'M ,.00 STATE ENCROACHMENT
--- _ PERMIT NO. 1
.,ERT IC TANK,SECT AGE PiT OR
.—
--" P TS AN ;OR DRA_INFIELD 2.00 INDUSTRIAL
�
CESSPOOL URYWE L -"''— WASTE APPROVAL
Y%...!A? CO°IDSTION4 ONLY 2,00 1— —.-- CHARGES
--'" ---- ---- CONNECTION CHARGE FSE
OWNEWS PEI3YT oo
T�ur+
pry�1 _.---- -------
AUTI O I ATIOIV tOTAL FEE
d �
REIMBURSEMENT FEE
HAVE HIS DATE CONF?ACTED WIT4 TNE HEREIN NAMF'D CON- S� �i {
SIGNEDTHIS F c DESCRIBED EXISTING D FL! N �7I' I� d s+I. DATE + INSPECTOR'S SICt ATURE
RACiGR TO C N EC"C THE FB..V,. CE„C'?..,
_ __ 1 —__ _ .... ----
TO Ir1E PUBLIC S..E'NER. — -- - �- --- -
NEW HOUSE 5EWFR
-r. :�'.."� _DAY Ot'_
OWNER OR ✓ CONNECT ADD 110NAL -
OWNERS A.GENT.� " _ BUILDING OR WORK _—
r :'�f{edl """J SEPTIC TANK SEEP, PITI5)
AND/OR ORAttd Fifa❑
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL 0
.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 REQUIRED BY LOS ANGELES COUNTY AND STATE'CF DISCONNECT PLUG AND .
CAL.IFORNiA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _Ac'.ANDON HOUSE SEWER _ I
DESCRIPFD RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS C1
x SEEP.PI'(t5) (� CESSPOgLS[]
SIGNATURE. _.
OF PERMITTEE
WILLIAM J.RUJC, OLfT.TY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY
BY BY /
BEAUTY DEPUTY