HomeMy Public PortalAbout9721 WEDGEWOOD ST - Sewer - 1970-12-04 - '
NA 6420 4' APPLICATION' FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE�DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS, SUPT. OF BUILDING }a
LOCALITY L�'d= Jr
FOR APPLICANT TO FILL IN CRA06555T. ,� ' ''°-
LEGAL �y
DESCRIPTION LOT NO. OWNER
BLOCK TRACT ep
NO. OF SLOGS.
SIZE OF LOT ^"-F NOW ON LOT O CIT ^ TEL.
BUELDINGS DISTRICT NO. GROUP MAP PROCESS. BY
a BK PG
CONTRACTOR
ADDRESS -'' .,'j/ 4e. r� CO EC ON 15ATA
� a
- � STATION �,( /fir} DEPTH
CI
.. I i ,TEL l (.•' A
LICENSE NO,..,.J y ,.' " " '� LIC CLAS LOWER MANHOLE REFERENCE �./�/ ! �
- _ 5' ��✓ R �
NO. DSS CRI TION OF ORK FEE _ TYPE OF CONNECTION +) LENGTH ROM
HOUSE SEWER CONNECTING TO ["fes X- CURB .P L./ M.L.7O L.
PUBLIC SEWER $5.00 ,•e—
SEPTIC TANK,,SEEPAGE PIT OR - P.C.NO. � — `� '"'f
PITS AND/OR DRAINFIELD f10.00 CO. IMP. NO. - �' _�!/,f
HOUSE SEWER CONNECTING TO
TRUNK PERMIT NO, ROAD PERMIT NO. CL.
PRIVATE DISPOSAL SYSTEM � $300 —�-- C
CONNECT ADDITIONAL BLDG OR AFFIDAVIT T. IVER EASEMENT RECORD.INSTR.NO. I DATE
WORK TO HOUSE SEWER @ $3,00 f
—� _OVFRFLOW SEEPAGE PIT,DRAINFIELD ___ 1. �_ C:)EXTN CESSPOOL.DRYWELL,MANHOLE @ $5.00
ALTER REPAIR OR
`--' ABANDON HOUSE --' Y'--- HWY,OR ST.WIDENING ' U
SEWER OR DISPOSA_L SYSTEM $3`00 J STATE ENCROACHMENT uj
_ _—___—_---_ --__ —�
PERMIT NO.
I _
" --------' INDUSTRIAL
/� v WASTE APPROVAL
LR�J PERMIT --��$ -----��200 _____._.__�_ CHARGES
�.1�
CONNECTION CHARGE FEE --^
AUTHORIZATION TOTAL FEE --------__-- —
I HAVE.'AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REiMBW RSEMENT FEE
TRACTOR TO,CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ---- —
TO THE PUBLIC SEWER. APPROVALS DATE fNSP ECG A URE
SIGNED THIS DAY OF 19_ -- -- -"
OWNER OR NEW HOUSE SEWER ' lif r
OWNERS AGENT_ CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PITiS).
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO/OR DRAINFIELD
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANC{S AND STATE LAWS REGULATING
PLU MBiNG AND SEWERS. - f CESSPOOL ❑ DRYW ELL ❑
I HEREBY GE I IFY I AM PROPERLY RE ST' kED AND/OR AL'fE R,REPAIR,SEWER OR
LICENSED AS RE UI BY.'LOS A LES COU Y�/AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR T AW THE LEG L OWNER F„Y AND INTEND 70 —
RESIDE IN, THE zf ESCI j F (DENT I,r' PERTY. DISCONNECT PLUG AND
� , d ABANDON HOUSE SEWER
SIGNATURE y✓ _ '—
OF
PSE 'TEBACKFILL BACKFILL SEPTIC TANKS ❑
SEEP.PIT IS) ❑ CESSPOOLS ❑
IL
VyALIDAT , JACK R. ALLEN
ti�
IOUPERVISING MECHANICAL ENGINEER
Ca _
M.O. CASH