HomeMy Public PortalAbout9719 WEDGEWOOD ST - Sewer - APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DIS►POSAL
Depent of County Engineer
County of Los Angeles BUILDING "°
i7 M.J. FOX, COUNTY ENGINEER ADDRESS
GASSATT D.GRIFFIN.SUPT OF BUILDING
LOCALITY
FOR CANT.T LIN CROSS ST. _�"� �. � �:>C 4
L._.
OWNER19 V �.
TRACT .,� - FFr� _.— - �FtAiL
NO OF� !`�: 6LO � y CITY . � TEL.NO.
.SIZE OF LOT �° lF � NOW ON LOT �
USE Of v
BUILDENGS DISTRICT N0. GROUP i MAP Pr
BK
CONTRACTOR !/"!7 A�
ADDRESS CONMCTION DATA
CITY f�+.L, NO. STATION 7 DEPTH "8
❑ STATE; _ #' MANHOLE REFERENCE
REGtSTRATION N0. eyq�P CJ COUNTY _ �+ f �" UPPER
£ — TYPE OF CON ECTiON LENGTH FROM y
NO. 1 DESCRIPTION OF WORK FEE Y• CURB P L. M.L.TO_P.L.
j HOt1SE 4EWFR CONNECTING TO =� I � �:'",r �` .{��e'E •"'' � ��q�,g,,,,, ..,�+
I
PUBLIC SEWER fry 5 3,50 )1
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 ---
�E
CONNECT ADDITIONAL BLDG. OR M—� -- NO. /�� .;OB. N0. -
Wo k ,O HOUSE SEWER
7.00_1 _C64— '4��
ALTER OR REPAIR EXISTING
_ TRUNK PERMIT NO. ROAD PERMIT N0.
I SEt,ER OR D.SPOSAL SYSTEM 1.00
�� DISCONNECT AND ABANDON SEWER I� STATE ENCROACHMENT
AND/O,I DISPOSAL SYSTEM__ 1.00 i. IPERMIT N0. _
SEPTICTA
SEE PAGE PIT OR —" ----
NIS A_NDIOR_DRAINFi ELI. 2.00 ( 'NDTE APPROVAL
j CESSPOOL• GRYWELLWASAPPROVAL
_SPECIAL CONDITIONS ONLY 2.00 CHARGES
i '-- CONNECTION CHARGE FEE
AUTHORIZATION ( TOTAL FEE
, �g'� RE[MBUR55ATENT FEE
I HAVE THIS DATE .CONTRACTED-WITH THE HEREIN NAMED OCR-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE 3NSPECTOR SSIGN.ATL'RE_ -_
TO THE PUBLIC SEWER
SIGNED THI,SS - DAY OFA___��. i9_
OWNER 01 CONNECT ADD NEW HOUSE SEWER — --- —
ADDITIONAL
OWNERS AG 'J __BUILDING OR WORK.
- S5T' PIT
(S)
TANK, SEEP,PIS)
.ADDRESS. _ AND/OR_DRAINNELD
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL[I
AND STATE THAT THE•ABOVE 15 CORRECT AND AGREE TO COMPLY -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING VALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEMA _
tHEREBY CERTIFY THAT i AM PROPERLY REGISTEIPEED AND/OR DISCONNECT PLUG AND
LiC.ENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE 'F
CALIFORNIA OR THAT I AM THE LEGAL O' R OF THE. A 'VE _ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. yam.-"� BACKFILL SEPTIC TANKS❑ '
g SEEP.PIT(S) D CESSPOOLS 0 ..
SIGNATURE P
OF PERMITTEE T
WILLIAM J.FOX,COUNTY ENGmErm VAIMATION
BY BY
DEPUTY DEFUTT
BY BY CK
DEPUTY -