HomeMy Public PortalAbout9678 WEDGEWOOD ST_Sewer__ 76A642D
12.54
d E•6oAPPLICATION FOR PERMIT1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING �r
WM.J. FOX. COUNTY ENGINEER ADDRESS
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C.ASSlcTT D.GRIFFIN.SUPT OF BUILDING LOCALITY q�
SSSS-----_-- �!-• � 'Yo -
NE4REST -�+T-
FO$ APPLICANT TO FILL IN
LEGAL
DE5CRPPTiON LOT NO. OWNERr
BLOCK __ �uTRACT ^' MAIL
-- - -
NO. OF BLDGS. ADDRESS
-
572E OFLOT - NOW_ CN.LOT �
USE OF _
!?_UILDINGS_ '; Pd�.,l : :. DISTRICT NO. I GROUP
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AP
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CONTRACTOR l'1+���1 �{{JJ
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ADDRESS J� ;Gb , '.< i�p ,f.d. :.� `�1 F + _ CONNECTION DATA
CITY � � - y.° TE:L. NO.14r- _ ��' STAT16Yt:1'' {:' DEPTH ! -
'L] STATE ` MANHOLE REE�REh E
REGISTRATION NO.
UPPCR � a yO_VER.
TYPE OF CONNECTO•T, LENGTH rRQ�!
N0. DESCRIPTION OF WORK FEE Y` CURB P L. M L TO P.L.
g
HOUSE SEWER CONNECTING TO
f PUBLIC SEWER
�I HOUSE SEWER CONNECTING TO {{
PRIVATE DISPOSAL SYSTEM 1 00 I ---
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0. �B�#t.T.. � E' -7
�
WORK TO HOUSE EWER 1.00 � .-iSSSS-_ —Co.
y�
ALTER OR R PAIR _ ING
D SPOSALSV SY5'TEM ICD TRUNK PERMIT NO. ROAD PERM lT NO.
DZSCONNECT AND ABANDON SEWER
AA D/ORDISPOSAL SYSTEM
- "--"—TATE_ENCROACHMENT
' _ PERMIT NO.
SEPTIC TANK, S=EPAGEPIT OR
P 1S Df OR DRpINFIELD 2.G0
..—_-----
INDUSTRIAL
WASTE APPROVAL �f
AL CONN TIONS ONLY 2.00
CHARGES IiE
CONNECTION CHARGE FEE -
VY11LI 1E$bUT � T i 00
AJTOIATiON
TOTAL FEE ^— j REIMBURSEMENT FEE
§0
I HAV£ THIS DATE CONTRACTED WITH THE HEPEIN NAMED CON- - i¢ �r
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS � DATE INSPECTOR'S SiONATURE
TO THE PUBLIC SEWER-' ---
'q WNEW HOUSE SEWER
SIGNED THIS r u DAY OF
OWNER OR > - CONNECT ADDITIONAL
OWNERS AGENT _ BUILDING OR WORK -
AODRI:S:___ SEPTIC TANK SEEP, PIT(5) —
._ _AND/01Z LRRI't-IELD _
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL GI DRYWELL
AND STATE THAT TI-5Z 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
L10ENS_D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF `DISCONNECT PLUG AND
CALIFORNIA OR THAT. I AM THE LEGAL OWNER OF THE ABOVEABANDON Y.OUS::SE�iIER -
DESCRIBED RESIDENTIAL PROPERTY. -_B,ACKFILL SEP 1.0 T'ANKS❑
SEEP. PIT(S} Lt CESSPOQLS 0
SIGNATURE .� _„. irk
OF PERMITTEE�..•"
WILLIAM J. FOX.C ' NTY ENGINEER ALIDATION
BY BY
DEPUTY DEPUTY
BY By ( f J
''� DEPUTY CEP3TY