HomeMy Public PortalAbout9718 WEDGEWOOD ST - Sewer - 1956-02-16 S&E4D APPLICATION FOR PERMIT 1
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DIV'!SION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING ,r
JOHN A. LAMBIE, COUNTY ENGINEER _.0.DDRE55
FD CASSATT D. GRIFFIN, SUPT OF BUILDING: LOCALITY
NEAREST - -„ - - --
_ FOR APPLICANT TO FILL IN
LEGAL.�_----- �g'1 -- ------- - - -
DESCH.1P71GN LUT NO. .-�' OWNER ..`.
---------- - '7y MAIL - - -
BLOCK_ TRACT _y '�°°-.a. - _ADDRESSNO.OF OF BLDGS. CITY TEL. N0.
SIZE OF LOOT ° NOW-ON L01' � �
BUIUSE Of DISTRICT NO. CROUP I MAP
BUtL.DING '- "' _C.wti-, z,� _
BK PG
CONTRA
ADDRESS -------_--._.__.__ CONNECTION DATA,-----_-- .,-_--
STATION �L.. - DEPTH
r .. "7 MANHOLE REFERENCE
.{ " .. ❑ STATE ._ -_--`-'- ,r OW ER
REGISTRATION N0. �:•t,;; / ,Ir°[I, COUNTY --- -`----
h 0. I)ESCRIPTI NOF WORK FEE -_---- ----.----------- ------
--�-HOUSE SFW 6R CONNECTING 70 - - TYPE OF CONNECTION LENGTH FROM
PUBLICSEWER_ @ $3.50 _ .' -- P L," M.L. TO P.L. .
SEPTIC TANK,SEEPAGE PIT 0'R
PITS_AND/OR GRAINFIELD_--_ CO) $3.00
OVERFLOW SEEPAGE PIT,DRA]NFIELD — P C NO.
:-� EXiN._CESSPOOL,_DRYWELL.,M.ANHOLE $2,00I _ CO. IMP.NO. J09 No. —
HOUSE SEWER CONNECTING TO ~
_ PRIVATE DISPOSAL SYSTEM__ tt�; $I.DO ( j TRUNK_PERMIT NO. -ROAD_PERMIT NO,.
CONNECT ADDITIONAL BLDG.OR__ _
STATE ENCROACHMENT
__WORK_TO HOUSE SEWER _____ (a $_!,00 _ __PERMIT NO _
ALTER,REPAIR OR ABANDON HOUSE - - INDUSIRIAI -- -- --� ----- --
SEWER OR DISPOSAL SYSTEM lg $1.00�_- WASTE APPROVAL
--j�'----------. _----. _ .- -_ CHARGES -
__ _ --
CONNECTION CHARGE FEE
-
OWNER'S __PERMIT _5 �^ 1 00 - --- ----- -
AUTHORIZATION TOTAL FEE -� ��V��
REIMBURSEMENT FEE
�
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
APPROVALS DATE 1NSPEC.TOR'SSIGNATURF
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - ------------ i - -�-- -- ---
TO THE PUBLIC SEWER. NEW HOUSE SEWER _
SIGNED THIS DAY,OF 19 CONNECT ADDITIONAL. --
OWNER OR - --%.� BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/'OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE: READ THIS APPLICATION
CESSPOOLD DRY'A'ELL L-1
AND SLATE THAT THE ABOVE IS CORRECT AND AURES TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBI"' AND SEWERS, SEWAGE DISPOSAL SYSTEM
I H BY CERTIFY THAT VXW PROPERLY R GISTERED AND/OR - DISCONNECT PLUG AND
LICE ED AS REQUIRED SY�.OS AN TELES CO. TY AND STATE OF ABANDON HOUSE SEWER
CA RNIA fJR THAT I A T'HE LEGAL NE. OF rHE ABOVE -- - --
---
DES RIBED k'LESIDEN7Fpl PR PE TY. �... BACKFILL SEPTIC TANKS Q
f-`4 SEEP.PIT(S) (L CESSPOOLS❑
OF ER?AITT
i
IOHN A. LA " BiE.COUNTY tNGINEER F ? VALIDATIO ROBERT A.WOOD>CHIEF PL8G. INSPECTOR
``d••'� CW. M. O.�'y CASH t'YQ� /' - ,t'!
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