HomeMy Public PortalAbout9706 WEDGEWOOD ST_Sewer__ E-6153 rt-ss APPLICATION FOR PERMIT 1
s
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Deportment of County Engineer
County of Los Angeles BUILDING kyr ,� t
JOHN A. LAMBIE: COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITYe Y
NEAREST r"9
FOIi APPLICANT TO FILL IN CROSS
LEGAL ---- -- OWNER
.t--s.- .- �..�
DESCRIPTION _LOT NQ .-_ --_
BLOCK — TRACT �,{� MAIL -
--------- �' PY �-- ADDRESS
N0. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
USE OF -
BUILDINGS_4 .-C-�e..4;' ,r,.n.P -- DISTRICT. NO. i GROUP MAP
BK PG
CONTRACTOR '
ADDRESS "Cyon-Y .,; =�zg-," , ra y _-- - -_ �_ NNEGTION DATA — --- -
CO T
--- ,•",�s+ ✓L� NO.
--- STATION ,4 -- DEPTH
NO
CITY `7 . - -
-- - ZZJ�L MANHOLE REFERENCE Depth-
_ D STATE
REGISTRATION NO. D COUNTY
NO. ! --DESCRIPTION OF WORK FEE _ --- --- ------- ---.-_
--'- - - ---- TYPE OF CONNECTI LENGTH FROM \
HOUSE SEWER CONNECTING TO
P.L."+ M.L. TO P.L.I P U B L i C
SEWER �� $3.50 ---------- -. -----
-_i SEPTIC TANK.,SEEPAGE PIT OR - --- -------_ --.._ _.. --- --
il P175 AND/OR_DRAINf I£LD aj $3.,00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. CO,
EXTN„CESSPOOL,DRYWELL,MANHOLE @ $2.60 i ,-I_-- -CO. IMP. NO. --.--105 NO.., ---_-----
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
� CONNECT ADffITiQNAL BLDG.OR I i STATE ENCROACHMENT
I_ WORK TO HOUSE SEWER (i $1.00 PERMIT NO.
~ ALTER,REPAIR OR ABANDON HOUSE - - � -
INDUSTRIAL
t SEWER OR DISPOSAL SYSTEM _- Ic.1^$,t_.00 WASTE APPROVAL
----�- --- -------- -- -- ----CHARGE---
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 1 00 ------ --- -------
AUTHORIZATION TOTAL FEE � �> REIMaURaEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS I_DATE _IINSPECTOR SSIGNATURE
TR.ACTO}? TO CONNECT THE. ABOVE DESCRIBED EXISTING DWELLING i -I}i--
TO THE PUBLIC SEWER. - NEW HOUSE SEWER
SIGNED THIS D Y OF iS_— CONNECT ADDITIONAL �s
OWNER OR BUILDING OR WORK___
OWNERS AGENT --- SEPTIC TANK,SEEP.PITS) -
ADDRESS._— AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE. LATUS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY�THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND G
LICENSED AS REDU D BY LOS ANGE a COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T'AT [ fyht THE LEG L OWNER OF itG ABOVE
DESCRIBED RESIDE IAL '�OPERTY, A BACKFILL SEPTIC TANKS D
y` SEEP.PIT(S) D CESSPOOLS[]
SIGNAT
OF PERMITTEEURE t � .✓J „/�,'�� --- —- -- — -- —�—'
1
IOHN A. LAMBIE>COUP-1Y ENGINEER w VALIDATION _F , ROBERT A.WOOD,CHIEF PLEIG. INSPECTOR
CK. M.O. d✓C.ASK,
,. " 2 4 FFR 6 4.5 r`