HomeMy Public PortalAbout9725 WEDGEWOOD ST - Sewer :76A'64E8Q8 II, AP_PL�A' TlON FOR PERMIT tg/1-7
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COUNTY OF LOS ANGELES SEWER—SEWAG 61SPOSAL
qII DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOIN.
B U'
JOHN A. LAMBIE, COUNTY ENGINEER AD.
COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY
BUILDING
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT
f AODRE
OF BLDGS, S*
SIZE OF LOT NOW ON LOT CITY/ '
TEL. NO.
USE OF
U GS
8 ILDIN DISTRICT NO. G MAP PROCESSED'AN
PROC
BK PG
CONTRACTO510
ADDRESS AV, s CORNECTION ATA
N
STATION DEPT.
9T—ATE MANHOLE REFERENCE _7
CLASS
/ UPPER
LICENSE N _
NO. I DESCRIPTION OF WORK—` FEE TYPE OF CONNECTION LENGTH
710M
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO
$5.00 F
PUBLIC SEWER P.C.NO.
--±-]•
SEPTIC TANK,SEEPAGE PIT OR
PITS ANO/OR DRAINFIELD 510.00 CO.IMP.NO.
H&WSE SEWER CONNEC TING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRfVATE DISPOSAL SYSTEM $3.00 tl
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIYEj CORD.INSTR.NO. DATE r.')
N
TO HOU
SE SEWER 1;3.00
i�i_ _PIT.DRAINFI-EL
OVERFLOW� EFAGF. 15 c:)
FXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 1.—
C-3
_E —STATE ENCROACHMENT
WL��iii sfifO�:Fk HWY.OR ST.WIDENING
VIIERORDJSItq�SALSYSTrm PERM_IT NO. c/.)
INDUSTRIAL
WASTE APPROVAL
OWNEW2 S PERMIT $i CHARGES
00
CONNECTION CHARGE FEE
AUTHORIZATION[TOTAL FEE I 7
I
I HAVE AT THIS
DATE A CONTRACT WITH THE HEREIN NAMED CON-
REIMBURSEMENT
TRACTOR TO-CONNECT THE ABOVE DESCIRIBED EXISTING DWELLING APPRO
TO THE PUBLIC SEWER. VFEE
PALS DATE ),,INSPEC7A
'S SIGN
SIGNED THIS—_DAY 'OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENT— CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SE",PIT(S).
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
ANIDSTATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWER4-" CESSPOOL [I DRYWELL ❑
HEREBY CERTIFY H I' AM PROPERLY RE (STARED AND/OR ALTER,REPAIR.SEWER OR
COU
I H
I
SE. FO
LICE R U, D BY'LOS AN: SE COU Y ;AND STATE OF SEWAGE DISPOSAL SYSTEM
Nr Ul
L,
LN
CALIFORNIA ORN'A I
CALIF I OR T 'THE �t NER OF,/AND INTEND TO DISCONNECT PLUG AND
RESIDE
T"
L
DE IN, THE 8 V SCR: ENTI,"!/ROPERTY.. ABANDON HOUSE SEWER
.,.N.T. . fe�
SIGNATURE BACKFILL
ILL SEPTIC TANKS ❑
PERM
EE� SEEP.rP,T S) ❑ CESSPOOLS
VAttDATIOIJ-- JACK R. ALLEN
CK. M.O. /CASH SUPERVISING MECHANICAL ENGINEER
7 is 9 71.-'---�; 4 1 r. D 7.0 0
-1100
76A 642D - CE&Oli - 9;`73. tT
PPLICN.AT'. FOR PE
A ■ ;��
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F'NEAREST
y
;W.. / '�,'- � (�✓ G. �✓' �.6�
_ / d
Y -o°s /%�..+'"
r. -� ,-
FAR APPLICAIy 7A FILL INUA-
LEGAL
DESCRIPTION LOP NO. L^ro- OWNER c
y� MAIL
BLOCK TRACT— J_.Y✓�_ _._ —_ ____ ADDRE55 ''_ `,f+�i�.. +* (,if;+"3. ,". >
NO. OF BLDGS. ..
SIZE OF LOT NOW ON LOT CITYpy+� .f l-d TEL. NO.
USE OF. . MAPES5E.0
BUILDINGS DISTRICT N0GROUP BUILDINGS--ees j C;�i" - K Pix tBY
CONTRACTOR fs/3 %:./ ,+LG.-.. y .,,,CJC' a iJ t„J
ADDRESS- COECTI®N
CITY :Kr:OX04--e'f,J'� �*r' ' TEL.. NO. w+,y '�1e°' y TATION DEPTH
STATE
LIC
UPPER
LICENSE NO:.. q Y7�Y/4+ CLASS r s �y ANHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. WL.TO P.L.
PUBLIC SEWER $7.00 -
SEPTIC TANK.SEEPAGE PIT OR —` JOB NO"
PITS AMD/OR DRAINFIELD E/0.00 CO.IMP�NO.`
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3:00
CONNECT ADDf TIONAL BLDG.OR AFFIDAVIT WAIVER. EASEMENT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER @ S3.00
OVERFLOW SEEPAGE PI'T.GRAINFIELD rgO
EXTN.,CESSPOOL.DRYWELL. t5.00G3
ALTER,REPAIR0MD'C4rt HOUSE HWY.OR ST.WIDENING
SEWER OR'0"-FP RBML SYSTEM @ $3.00 ' - ga
-- STATE ENCROACHMENT y�
MANHOLE @ $7.00. PERMIT NO. CZ516 a 00t±17 C13
-- INDUSTRIAL LLJ
Q-
WASTE APPROVAL CfJ
CHARGES �
OV{iMER`a PERMIT ---- Ts
AUTHORMATION' TOTAL FEE 0 CONNECTION CHARGE FEE _
I HAVE AT THIS. DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING --7� '--'-
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT — -
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY — ----
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING
P:LU MBI NG.AND SEWERS. CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED .AND/OR ALTER,REPAIR,.SEWER OR I
LICENSED AS REOWRED BY LOS ANGLES COUNTY AND STATE OF 'SEWAGE DISPOSAL SYSTEM
CA'IFC.RNIA OR THAT,L M THE LEGAL,9WNER OF, AND INTEND TO ---- `-"-_-_-�
DISCONNECT PLUG AND
RESIDE IN, THE ABOA0E 5C IBE :D T AL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE ----
OF PF4RM"TEE J/) A' ": BACKFILL SEPTIC TANKS. ❑
T _-- - g��}�y yq+pSTEEP..�PITaS) ❑ C.ESSPO.OLs. ❑
VRYAxi# ATIOLa M.0. CASH
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