HomeMy Public PortalAbout9712 WEDGEWOOD ST_Sewer__ I
76AC42D�,
S a sees 11-55 AS FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT OF BUILDING
LOCALITY
NEAREST ro
FOR APPLICANT TO FILL IN CROSS ST. (tiZ- V 4J'
LEGAL
DESCRIPTION. LOT NO.
MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY 'TEL. NO,
USE OF
JHUIUD N G S DISTRICT NO, i GROUP MAP
_
BK PG
CONTRACTOR
y CO TION DATA
ADDRESS
— j-
CITY TEL. NO,L,�' ' STATJ ON DEPTH
MANHOLE REFERENCE
STATE
[I COUNTY
REGISTRATION NO.
NO. _DESCRIP' ION OF WORK ;/FEE!t Y
HOUSESEWER
--- TYPE OF CONNECTION LENGTH FROM
--'.W—E-R-C--O--N—fl-E-C-TiNG TO L7
PUBLIC SEWER @ $3.50 3 S-wio*- /P.L. M.L.TO P.L,
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $3.00
OVERFLOW SEEPAGE FIT,DRAINFIELD P. C. NO, S
EXTN-,CESSPOOL,DRYWELL,MANHOLE $2.00 CO. IMP, NO. JOB NO.
�_ PRIVATE HOUSESEWER 0
DISPOSAL SYSTEMECTINGTO (v $1.00 TRUNK PERMIT NO, ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.OR -STATE ENCROACHMENT
WORK TO HOUSE SEWER Q) $1.00 NO.
-ALT—ER,--RE -P-A1R 0--RA-B- ,AN-D0--NHOUS —E
SEWER OR DISPOSAL SYSTEM 1.0 INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S TOTAL
NERMIT S 1 00
i L -
T�– I :z REIMBUR§EMENT FEE,
AUTHORIZATION TAL 1. �4 :;j
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS____' DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNF.c,r THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THIS DAY OF—' -19— CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS- AND/OR DRAINFiELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL0 DRYwELL0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED As REQUIRED BY LOS A E'l CO nify ANDHSETATE OF ABANDON HOUSE SEWER
C, 'T I `Lk, 0 OF,,T ABOVE
CALIFORNIA A AM THE
DESCRIBED R E'THAT
L PROPER�11Y.
BACKFILL SEPTIC TANKS 0
I
SIGNATURE
00 i A," SEEP.PIT S) CESSPOOLS
OF PERMITT i
IOHN A. LAMBIE, qUNTY ENGINEER t VALIDATION ROBERT A. WOOD,CHIEF PLBG. INSPECTOR
CK. N,0. CAS it
2 2 1 45
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