HomeMy Public PortalAbout9711 WEDGEWOOD ST_Sewer__ S&E.66:3 3155 v APPLICATION FOR . PERMIT
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING ✓
WM.J.FOX, COUNTY ENGINEER -ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY 'T-'� 4 - �f'ry '
_ FOR APPLICANT TO FML IN NEAREST
LEGAL , -
DESCRIPTION LOT NO, OWNER y 3'
BLOCK TRACT a y _MAIL
NO. OF BLDGS,
S72_E OF LOT-y ""''
NOW ON LOT CITY _-- TEL. NO.
BUILDINGS
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USE `v °=- ./. <'
_ NGS_ DISTRICT N0. I GROUP I MAP
CONTRACTOR 3 f i BK PG
ADDRESS CONNECTION DATA
CITY ,, - TEL. N0. �; i "tri~ _ STATION 'L" �`' - `,.+` DEPTH _
u STATE MANHOLE REFERENCE
COUNTY
REGISTRATION NO. ,{� G' '� _ _•..'' 9d ;v,_ ^- 4 LAVE
€ .d�V �' �
. rr �
NO. DESCRIPTION OF WORK FEE -----_-_. --
HOUSE SEVVER CONNECTING TO I TYPE OF CONNECTICxr- Lr.L,TO FROM -
tU LIC SEWER �:� M.L. TO P.L.---- — �' $- 3.50 .
i HOUSE SEWER CONNECTING TO
--'-( PRI dAlr DISPOSAL SYSTEM
CONaIECT ADDITIONAL BLDG. OR P C NO ---
NJURK TO HOUSE SEWER_ _ 7.00 N_O._
—� ALTER OR REPAIR EXISTING TRUNK PERMIT N0. _ ROAD PERMIT N0.
SEWER OR DISPOSAL S7STE_M _ 1,00 TRO
�^
_! DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT — ^'
AND/OR D-SPOSAL SYSTEM 7.00 i I PERMIT NO.
SEPTIC TANK SEEPAGE PIT OR --- ! 1—T ----- ---- ------ --..
PIT AND/OR DRAINRIELD 2.00 INDUSTRIAL
-- .— =
WASc APPROVAL —.
CESnP001 DRY'WELL
SPECIAL CONDITIONS IONS ONLY 2..00 CHARGES
�.7 --------- ----T---- ____ ___
-
CONNECTION CHARGE FEE
PERMIT ----A----�.—_—___
OWNER'S S 1 Oo --- --- _— _
'7 _— v � ✓''`- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE �I �; REIMBURSEMENT
1 HAVE THIS DATE CONTRACTED Vv ES THE HEREIN NAhCON- APPROVAL
TRACTOR TO CONNECT' THE ABOVE DESCRIBED EXISTING DWELLING
S DATE INSPECTOR'S SIGNATURE ELLING w7
'TO THE PUBLIC SEWER "-- --- -- - --------
NEW HOUSE SEWER
SIGNED THIS —DAY OF. 19.. _OWNER _
CONNECT ADDITIONAL
OWNERS AGENT �':J .*'"tl _ BUILDING OR WORK _
�� SEPTIC TANK, SEEP, FIT(S)
ADDRESS-- _..__. � ..AND/OR DRAI_NFiELD _
1D HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[D ORYWELL
AND STAT£ ]'HAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ALTER,REPAIR, SE
PLUMBING - —»
PLUMBING AND SEWERS, _SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Ml
LICENSED AS REQUIRED BY LOS AP{GELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIUVI) RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS[7 �^
SEEP. Pii(5) (] CESSPOOLS[-'j
SIGNATURE J/ -
OF PERMITTEE
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF f LOG. INSPECTOR