HomeMy Public PortalAbout9724 WEDGEWOOD ST - Sewer 78Ar
re-66s a.5s APPLICATION FOR PERMIT
s& .s�
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engines
County of Los Angeles BUILDING -
WM.J. FOX, COUNTY ENGINEER ADDRir S
CASSATT D.GRIFFIN,SUPT OF BUILDINGS LOCALITY -FOR APPLICANT O FILL IN NEAEST ST.
LEGAL ]�r-�- y ate. },_.,• OWNER ---- --
DESCRIPTION _L07j,
BLOCX TRACE MAIL
NO.OF BLDGS.
SIZE OF LUT NOW UN LOT CITY TEL.NO.
USE OF
�3UTLDLRGS - _ _ DISTRICT NO. GROUP LEAP
BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL. NO STATION DEPTH
STATE MANHOLE REFERENCE 1 j w� _ liPPER_
REGISTRATION NO. COUNTY
DESCCRIPTiON OF WORK----FEE --.-- ---- —_-- --- -- __---
--/ — - - - - .TYPE OF CONNECT/ LENGTH FROM
HOUSE SEA FR CONNECTING TO
PUB L IC S E,,FR $ 3.50
-I HOU5E SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 _
�CUN TECT RDDi'TIONtL BLdG. OR --� --- P C. NO. -- -�_
W URI{ TO HOUSE SEWER 1.00 C.."=_I FAP NO.. •:rtrb-Qr�.
ALTER OR REPAIR EXISTING
SEVdER_OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0: ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT `- --_-�__-- ---�-
AND/OR D SpOS:S YSTEM§ 7.00J_ PERMIT NO.
PITS AND/OR DRAiNFIELD 2,00 INDUSTRIAL
T� CLSS_v00L DRYW FLV -- - - '-- WASTE APPROVAL
SPECIAL CO _DITION3 ONLY 2.00 CHARGES -
i
�Y
OI�VNTERIS PERMIT � --1 00-
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE �; REIMBURSEMENT FEE
1 HAVE THIS UA'TE CONTRACTED WITH "HE HEREIN NA.iA.E:D CON. �+
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWrLLINC APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S'W F R - --------- - _.------
NEW HOUSE SEWER
SIGNED THIS _,DAY OFA.._
OWNER OR
CONNECT'ADDITIONAL
---"• -
OWNERS AGENT.- _BUILDING OR WORK
-��--__
- !-'�—_^---- -----�---- SEPTIC TANK, SEE?, PIT(S) - --_._---.—
ADCRES5— _
AND/OR DRAiNFEE6D
AN
HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION Cr'.S'S."+OOL(=j URY'rVELL L;_)
A"eD STATE-. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS RECULA'TiN•u
PLUMBING AND SEWERS. 4R
O
ALTER,REPAIR, SEWER i -
_
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/UR -SEWAGE DISPOSAL SYSTEMOR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE: LEGAL OWNER OF THE ABOVE _ABANDON HOUaE SEWER W�
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS C
SEEP. PIT(S)-L-] CESSPOOLS[]
SIGNATURE - -OF PERMITTEE.
PERMITTEE.
WILLIAM J.FOX. COUNTY ENGINEER VALIDATION R A.WOOD, CHIEF PLBG. INSPECTOR