HomeMy Public PortalAbout9734 WEDGEWOOD ST - Sewer 'fiA 6420 - CE8Q8 - 9/73 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FSS
- t `_
FOR APPLICANT TO FILL IN
LEGAL "}
DESCRIPTION LOT NO. Pte.itc" 4ef OWNER .;''�;
gg MAIL
BLOCK TRACT I i fps r_.,C- ADDRESS �( !
_ NO. OF BLDGS. y —�
SIZE OF LOT',+1j`�",, j(' _ NOW ON LOT 4 E.- CITY 1 l' - TEL. NO.
USE OF DISTRICT NO, GROUP MAP ED BY
-BUILD I NOS i C'^I 'C`').--�L" 4 '^Y��`'��.�L..`(" �'\ a l l:''rti f:'. -' t / 'yy -�- SK I,P$�'y
EONTRACTOR "`� a v 4d �� � /T)_ / A�'
ADDRESS 1 �,, - y;,r;�,y, !�. y, CONNECTION DAT
-�
CITY Y '1�1.�C (,'j _ y TEL NO. STATION DEPTHi_
STATE LIC MANHOLE REFERENCE UPPER
LICENSE NO: CLASS LOWER
NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER.CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $7.00 -
SEPTIC TANK.SEEPAGE PIT OR P.G.NO.
JOB NO.
PITS AND/OR DRAINFIELD f $(0.00 CO. IMP.NO.
HOUSE SEWER CONNECTING TO Y TRUNK PERMIT NO. ROAD PERMIT NO,
PRIVATE DISPOSAL SYSTEM $3.00
WAIYEE
CONNECT ADDITIONAL Yilei6wpAe .P..� AFFIDAVITTEASEMENT RECORD.INSTR.
WORK TO HOUSE SEWER $3.00 I [yam
OVERFLOW SEEPAGE PIT.DRAINFIELD ry U
EXTN.,CESSPOOL.DRYWELL. _ 0 $5.00 HWY.OR ST:'WIDENIN�G � �%�y'/
ALTER,REPAIR OR ABANDON HOUSE "+' ryi �
SEWER OR DISPOSAL SYSTEM 0 $3_00 STATE ENCROACHMENT �y
MANHOLE ! $7,00 PERMIT NO. (,.:� W
-- -- INDUSTRIAL d
WASTE APPROVAL
OWNER'S PERMIT s! L O. CHARGES ^^
tea — CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC EwE R..a'y APPROVALS DATE INSPECTOR'S SIGNATURE
OWNERS AGENT h!\A, Y F -, 1-'".b r.•� )g _
" I, Y
OWNER OR 4'A � G \ NEW HOUSE SEWER
�'\—s--- 9 �'�-4t CONNECT ADDITIONAL
t BUILDING OR WORK
ADDRESS _
SEPTIC TANK,SEEP,PITS)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING
PLUMBING AND SEWERS. CESSPOOL ElDRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR _
LICENSED AS REOVIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAI I FCRNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A OVE DESCRIBE? RESI0FNT1AI. PROPERTY. ABANDON HOUSE SEWER
SIGNATURE L` BACKFILSEPTIC TANKS ❑
OF PEQMfT7EE_..:5_ �1 �_ -�_f_t�'
SEEP.PIT(S) ❑ SPOOLS ❑
VALID T N CK. O. CASH
3 7 4i'-Wvt �t3 � Ii .tl � Ase
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6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION
FA
SS
A OPF
JOHN A LAMBIE. County Enginee.
WMLIAM A. JENSEN, Sup't of Building
LOCAL,lTy
N N
EARES'
CROSS
FOR APPLICANT TO FILL IN
LOT NOWNER
MAIL A
8 CC K T,ACT
ADDRE s.
BLD S. V,
NO, OFG
SIZE OF I-OT NOW ON LOT --mL. N0
LIS E OF Pi{:
0. fiROiJP MAP PROCESSED Py
F'C
SK
A
OR
ADDRES53qua xf 1" CONNECTION DATA
L4
STATION DEPTH
L
STATENIAPv ii=O LE A1111ERENCE
R Gl,--T TION N0 COUNTY
-a WE P.
No. DE:.SCRIPTION OF WORK FEE TYPE,OF CONNECT[ON LENGTH FqQFA
—1-- -- — I Y, CURB P.L. M.L.TO P.L:
ROUSE SEWER CONNECTING TO
11-UBICSEWFR @ tS.00
P.C.NO.
SEpT 1C 7,�NK,SEEPAGE FIT 02
T$ANO;'O1?DRAINFIELD $10.00 CO' mp� NO. JOB NO.
H-'ISE SEWER-:ONNE=INC TRUNK PERMiT NO, ROAD FERMWT-NO.
PRIVATE OrSPOSAI.SYS EM @ S-5.001
REC�6-.HNSTR�NO. DATE
VirRK
C-N N,F CT AOD!TONA,.BLDG.OR AFFIDAVIT WATYCK: FA$ZMENT
-rc HOUS -SEWER $3 0o
-0 VER-F L O-W-SE Z Face P I T,L)R A 1 N F E.L.0
EXTN�CE5SPOOL.I.DRIWELL 14ANHCLE A $23.00
HWY.OR ST WDENING
ALTER, R RF"AIOR ABANDON H,'-ISE
D i SPOSAL.SYF�THM Q $3,00
R STATE ENCROACHMENT
_FF.RM!T NO,
WASTE APPROVAL
pmMI—
vmR OT 2', 00
AUTO $1
-- CONNECTION CHARGE FEE
HORIZATIN TOTAL FEE
I HAS'F AT THIS DATE A CONTRAI-T W;TH YHE HEREIN NAMED CON-
REIMBURSEMENT FEE
T RACT R TO C,-)NNE -------
DATE t11NSPCCT11 -55'GNATU—
""JE nES('-R!BE0
1pr
TO TWE Pu C SEWER'
SiGNED THIS DAY OF-------19--
OWNER OR NEW HOUSE SEWER
OWNERS AGENT------------- C 0 N N E CT A DpJ;r4 Gt,[A L
BUfLOING 1rY O4YET , l
Ai CPE55
SEPTIC TA NK P I(S)
F.EVY ACKNOWLEnGE THAT I HAVE READ THISCTM ANDIOR DRAINFIELD
AND
STATE THAT r O'iK ADOV,", IS CORRrCT ANAG o COMPLY
WITV4 ALL COUN r Y ORDINANCE S AND 81
ATE LAWS
To COMP
PL
UMB
iNG AND SEWFRS. C E'55 T DRYWELL
— .-_...—
P. CERTIFY "HAI. I AM PRORrHL' REG�STERED AND/OR ALIER,REPAIR,SEWER OR
LIC REQUIRED BY L.OS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYS,EM.
.ENSED AS I AM THE LEGAL OWNER Or -- I.__-—------
C A I
I-11FORN A OR THAT AND INTEND TO DISCONNE�CT N,�iG AND
R E LiIDE IN, THE ASO KDE5CRIBED RESE05N-AAI,. tROPERTY ABANDON HOUSE SEIVER
SIGNATURE
ILI,SE 7.1 TANKS
0i FE',�MITT 9ACKr s--POOL�s
E P.PIT(s) L-j C E.
VALIDATION- ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
6 6 1i J U L
3.