HomeMy Public PortalAbout9713 WEDGEWOOD ST - Sewer - 1957-03-21 7&E°66 APPLICATION FOR PERMIT 1
>&E-663 19-%5
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineers
County of Los Angeles BUILDING
J0f-4N A. LANIBIE, COUNTY ENGINEER ADDRESS 1 k ----
CASSATT 10. GRIFFIN, SUPT F BUILDING LOCALITY C
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. --
LEGAL
DESCRIPTION _ LOT NO r OWNER - ,,y.y� &r r�
r - -�--
MAIL
BLOCK TRACT . ' ADDRESSJ'
_-NO,OF BLDGS CITY TEL. NO,
SIZE OF LOT '&°yam r NOW ON LOT �-
USE CP DISTRICT NO,. i GROUP MAP
BK PG
UILDINGS ._
CONTRACTOR l _
_NT ._-
CONCONNECTIONECTION DATA
ADDRESS
-- — _-
CITY . TEL. NO. .� STATION ++'" y_ b
DEPTH --
. `MANHOLE REFERENCE
STATE3' e k �LOWER
REGISTRATION NO.
NO, ! DE,SCRIPTiON OF WORK FEE - ------- --- --
HOUSE SEWS} CONNECTING 70_-_- -- --_-- --- TYPE OF CONNECTIO -� LENGTH FROM
i i Y. CURB P L: M.L.TO P.L.
-PUBLIC SEWER _ _ -_ _-.@-5 3.50 1 -- -- - --- ---
SEPTICTANK SEEPAGE PI7OR - -- - f
-� PITS AND/OR DRAENFIE' D _ _=tc $'3.00J
. _� -�- - _ -- - --------------_-
OVERFLOW OW SEEPAGE PIT DRAINFIELD , ,, r'yf P C N0.
.j_ EXTN.,CESSPOOL,DRYWELL,MA MANHOLE Ca _$_200NO._.� � f.� JOB
NO. _
_ _ - ---
HOUSE SEWER CONNECTING TO - -
PRIVATE DISPOSAL SYSTEM 1,00 I TRUNK PERMIT NO, ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER C $1.00 -- L - _ PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
�--1SEWER OR DISPOSAL SYSTEM r_$1.00
- .--- -- __ -- _. 1 ----_ WASTE APPROVAL -.
i
J--�-- CHARGES
--�---- -. -. CONNECTION CHARGE FEE -
OWNER'S PERMIT 3 1 OD --- --- - ------ -
----- -- -- -'--- REIMBURSEMENT FEE
AU'T'HORIZATION T®TOL FEE j �
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- __ __ APPROVAL_"S - DATE �INSPEC'COR SSIGNATURE.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING � t
TO THE PU'BL;C SEWER, NEW HOUSE SEWER
SIGNED THIS DA' OF t9 _
CONNECf ADp1'ItONAL
OWNER OR s = BUILDING OR WORK
OWNERS AGENT_� -- ---... ------�-
-- SEPTICTANK,SEEP, PmS)
:ADDRESS AND/OR DRAINFIELD,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL DRYWELL❑ ' f
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,BONER OR i
PLUMBING AND SEWERS: _SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/O$ DISCONNECT PLUG AND
LICENSED AS REI';,•_ ED BY LOS ANGELES COUNTY DID STAT F' ABAN_D DISCONNECT
L SAND _
CALIFORNIA THA I NiM TH EGAL gWNER F/7HE OV•E �-------
DESCRIBED. SIDENTI,L p P EXY >r BACKFII L EPTIC TANKS El
T -
SIGNATUR SEEP.PIS) J CESSPOOLS E3
OF PERM TEE
I
IOHN A. LA I COUNTY ENGINEER -----VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
(0 (CK. b1, Q. CASH
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