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HomeMy Public PortalAbout9703 WEDGEWOOD ST_Sewer__ ED S 663 t1-55 APPLICATION FOR PERMIT S&E•6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Departrnent of County Engineer County of Las Angeles BUILDING JOHN!A. LAMBIE, COUNTY ENGINEER ADDRESS - ��,�:. '� �- .��' y,+��:✓�'�`+�.i CASSATT D. GRIFFIN; SUP'TOF BUILDING LOCALITY ....�_ > ,? �✓`'t NEAREST - _ FOR APPLICANT TO FILL IN cROSs ST, LEGAL DESCRIPTION LOT N0. -'' _---_---. OWNER! ,>_y.��- MAIL BLOCK TRACT „� a,�``"p' ' ' ADDRESS - - NO. OF BLDGS. CITY TEL. N0. SIZE OF LOT NOW ON LOT USE OF DISTRICT NO, GROUP MAP BU1LD[NGS %. ,i" �. BK PG CONTRACTOR,��'" ✓ - Jr ``>.''`i'— s��t• i- -� .�.-� y �r:: ADDRESS. ,,>�'.. .-. .`" `�r --- --------- CONNECTION DATA -_._.------- 5 _ - STATION v � - CITY 0 TEL. N0, .._-_. - DEPTH - La �.� - ' ' - MANHOLE REFERENCE STATE REGISTRATION NO•f3 - - -[j COUNTY NO. DESCRIPTION OF WORK FEE --- TYPE of cGNxEc35n5 --_----- -•------ _ PUBLIC SEWER —-^-----acs S-3_50 I _ Y—.�.-- CURB_ p LENGTH FROM HOUSE SEWER CONNECTING TO M.L.TO P. SEPTtC TANK,SEEPAGE PIT OR -� PITS AND/OR DRAINFIELD C $3,0 I---._ -- ----i-'-� - - - —— ----- OVERFLOW SEEPAGE PIT, DRAINFIELD IP.c. NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE (a): $2.GO j C ;"-- afaRr�f'r01'_ O _ j HOUSE SEWER CONNECTING TO I PRIVATE DISPOSAL SYSTEM ('t $1.00TRUNK PERMIT NO. ROAD PERMIT NO, CONNECT ADDITIONAL BLDG.OR STATE ENAC9MENT WORK TO HOUSE SEWER ( 31.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSEi --- INDUST'RIAL ,,.�"-'� '-..--- -- SEWER OR DISPOSAL SYSTEM fU $1.00 WASTE APPROVAL CH. CONNECTION CHARGE OWNER'S PERMIT t 00 ----- ---- AUTHORIZATION TOTAL FEE � REIMBURSEM ' FEE _ I INSPECTOR SS(GNATURE I HAVE AT THIS DATE A CONTRACT WITH THE H€REIN NAMED CON. --- A_---PDATE PROVALS____-----. TRACTOR ----.-.__.___-- TO THE ABOVE DESCRIBED EXISTING DWELLING - TO "iHE PUBLIC SEWER. NEW HOUSE SEWER I i SIGNED THIS Y 19CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AG .�� ENT ; � ._ :aFv, SEPT'IC TANK SEEP,PIT(S) _I—^ ADDRESS ,'° a _ _AND/OR DRAINFIELD �I HEREBY ACKNOWLEDGE THAT F HAVE READ THIS APPLICATION � TI AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO CESSPOOL n DRYWELL❑ COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ~+ LICENSED AS REQUIRED BY LOS ANfxTELES WcpUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE- LZGAL yOWNER OF THE ABOVE ------- -- - ------- — _ -I -.--__ DESCRIBED RES D p'XIAL PR©'PERTYJ r ,+ ,/ 1 BACKFILL SEPTICTANKS❑ SIGNATURE t r y ✓'�.. —SEEP.PITt.5) l.J CESSPOOLS El OF PERMITTE ✓ Jp ,.,;, --- --- -- —IT 7 IOHN A. LAMBIE,COU *ENGINEE VALIDATI ,.t, ROBERT A,WOOD,C.IEF PLBG. INSPECTOR (' 1 v 4"5