HomeMy Public PortalAbout9700 WEDGEWOOD ST_Sewer__ �-5°s
S6It-66
S S>C•66iJ APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEW E R -SEWAGE D I SPOSA L
Department of County Engineer
County of Los Angeles BUILDING X1.7 / d
ADDR..55 ./ ..—
WM.J. FOX.COUNTY ENGINEER -
CASSATT D.GRIFFIN, SUP°'T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS
CR
NEAREST
'?
LEGAL _
DESCRIPTION LOT NO. i� OWNER
BLOCK- TRACT 3 _;DMAIL
ADDRESS-
_- -
N�b. OF BLDGS.
SIZE OF LOT ,,, �NOW ON LO CITY _ TEL. NO.
USE OF - - -�
BUiLa,ING5ivt✓_}�3 DISTRICT NO. ' GROUP MAP
BK PG
CONTRACTORe
ADDRESS " �g,> �® y CONNECTION DATA
CITY - 7£L. NO. `" C✓ STATION . DEPTH
El STATE MANHOLE REFERENCE / °'� UPPER
-
REGISTRATION NO. ;?_ ',7 - _ --- [] COUNTY - .-_.._.x?.c
NO. DESCRIPTION OF WORK FEE --- --- — _ -- — --------
_-_� --
-- -- TYPE OF COPvNcC710 ' LFNGTH FROM
r
HOUSE SEtvER CC't'.NC+,71ir`G TO -7v - ,
f ! PU.B L.IC SENFR (U $ 3.501 L,e -Y' CURB P.L M.L.
HOUSE SEWER 0.014 CTING TO
PRIVATE DISPOSAL SYSTEM t.00� - - ----- -- -- -. - ---
' CONNECT ADUI 10NAL BLDG. OR _ ---1 i --� P C NO
_I_WORK 70 HOUSE SEWER - 1.00_
1 ALTER OR REPAIR EXISTING
I EWER OR DISPOSAL SYS_TEM___ 1.00 TRUNK 1I - TRUNK PERMIT NO. - - ROAD PERMIT NO, -
`�I ll SCONNECT AND ABANDON SEWER { yl� - STATE ENCROACHMENT
AND/CR DISPOSAL SYSTEM_ t.CO 1_— ( _ STAPERTET NCRO
SEPTIC TANK, SEEPAGE PIT OR INDUSTRIAL -
P 7�AND/OR DRAINFIELD-
CE�SPC70L- DRYWELL w WASTE APPROVAL
SPECIAL CONDITIONS ONLY -��_. CHARGES
-i.. -_�_.._-._...._-._..-_
--' - CONNECTION CHARGE FEE
O R's PERMIT
----
AUTHORIZATION --
TOTAL FEE - +� � r R_IMBURSEMENT FEE
� �v�
f HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- v-�...,..�r..�_.
TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING. D!4 LI.NG APPROVALS -DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER -- -.-- --- -- --_ 4441 -- ----- ---' - __.._.--
NEW HOUSE SEWER -
SIGNED TY.iS�.___-_..DA.Y Ot� ____-19_—
..CONNECT ADDITIONAL
OWNERS AGENT- -�---- _------
OWNER OR ky'f � EUiLD1^,S CR WORK
_ YL_ - - - ----
SEPTIC TANK, SEEP, PIT(S). -
AUD_RESs':.— ---,---------_-- -'-__ _ AND/OR D_RA-i_N_FIE_LD__
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL L
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND $TATE LAWS REGULATING ALTER, REPAIR SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND .STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVEABANDON_H0USE SEWE i2
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.
PIT(S) ❑ CESSPOOLS 0
SI GN
OF PEIxiI# F
WILLIAM J.FOX.CO 'TY ENGINEER V FiTION R.A.WOOD. CKIEF PLOG. INSPECTOR
c"� ti