HomeMy Public PortalAbout9679 WEDGEWOOD ST_Sewer__ 7EA
E-668 11.55 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
JOHN A. LAMEBIE, COUNTY ENGINEER ADDRESS
D CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY - -
APPLICANT TO FILL IN MEAREST
LEGAL
DESCRIPTION LOT NO. MAILvz
It j�,,,,� -
BLOCK-- 'TRACT /Y�-.�CTJ. f:�F tL, ,,,* _ADDRES
NO.OF BLDGS, CITY
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USOF
BUILDINGS DISTRICT NO. . GROUP -� MAP
CONTRACTORIK� �P ,
_ CONNECTION DATA
ADDRESS ------
T STATIONSDEPTH
MANHOLEREFERENCE - __-R
CITY .,� L.,1ti, TEL N0. •1< L L ,-... __. --___
- � ,F,,_
Ll STATE 'k? _- LO E
REGISTRATION NO, _ i h .�t.— ❑ COUNTY
No. DESCRIPTION OF WORK ^FEE` � TYPE OF coxNEcrio LENGTH FROM
HOUSE SEWER CONNECTING TO Y. - CURB P. _ M.L.TO P.L.
i- PUBLIC SEWER $3.b0 "} .
I SEPTIC TANK SEEPAGE.PIT OR �I -
PITS AND/OR DRAINFIrLD (d, $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELDr P. C. NO.
ETN CESSPOOL,DRYWELL_,MANHOLE «� $2.00. C0< IMP. N0. JOB NO. --
HOUSE SEWER CONNECTING TO
I RIVATE DISPOSAL SYSTEM cit $1.00 I i TRUNK PERMIT NO, ROAD PERMIT NO.
CON NECT ADDITI ONAL BLDG OR. STATE ENCROACHMENT
WORK TO HOUSE SEWEP. _ _ fa $t_._00 �_ _PERMIT NO
ALTER,REPAIR OR ABA14DON HOUSE INDUSTRIAL_------ -
_—i SEWER OR DISPOSAL SYSTEM c 1.0U �._ I WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT ---- -..__—� -------------- -- --
AUTHORIZATION TOTAL FEE ---_ - REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. .. _ �
APPROVALS DATE INSPECTOR'S SIGNATURE
---- '--'------
TRACTOR 1'0 CONNECT THE. ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEVER, NEW HOUSE SEWER I '
SIGNED THIS__DAY_DAY OF _._____ 19 CONNECT ADDITIONAL
OWNER OR ' ` BUILDING OR WORK I
OWNERS AGENT--f— "'; �.,; " .;; %
's�'"-� - SEPTIC TANK,SEEP,PIT(S)
ADDRESS -AN U,/OR DRAINFI�LD
1 HERE8Y ACKNOWLELGE THAT S HAVE READ THIS APPLICATION' CESSPOOL L] DRYWELL LJ
AND. STATE YKAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W.iTH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.,REPAIR,SEWER OR I I
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
--
1 HERESY CFR i'y THAT t AM PROPERLY REGISTERED AND/OR -- -- ----- - -�- -'i i
DISCONNECT PLUG AND
LICENSED AS KEQUiRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM- THE LEGAL OWNJ k OF THEAfiOVF. _ABANDON HOUSE SEWER IV —
DESCRIB;_DRESIDENTIAL PR,'i PERTY. r BACKFiLLSEPI CTANKS
SfGNA?URE CESSPOOLS' I-
._——-OF PERMITTEE
JOHN A. LAMBIE, CoU TY ENGINEER '"VALXDATION ROBERT A. WOOD, CHIEF PLEG. INSPECTOR
CK.' l M. 0. (.AbH
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