HomeMy Public PortalAbout8711 WENDON ST_Sewer__ raAaso APPLICATION FOR PERMIT 1
;eaos•a•�e COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER,
BUILDING AND SAFETY DIVISION
BUIL
DING
JOHN A. LAMBIE, County' Enginoor ADDRESS � �d ✓ � 3 �I
CASSATT D. GRIFFIN,Suptof Bonding _LOCALITY �T I `' e
NF,ARI
FOR APPLICANT TO FILL INCROSS 5T.
LEGAL
DESCRIPTION LOT 140. OWNER
BLOCK TRACTMAIL.,`( _ADDRESS f
—� NO.OF BLD
r '
SIZE OF LOT NOW ON LOT CITY TEL.rlIi.a
USE OF
BUILDINGS DISTRICT'N0. GROUP -MAP PROCESSED BY
CONTRACTOR r PG
ADDRESS "
CON EC�N DATA
CITY TEL.NO. STATION DEPTH
STATE MANHOLE REFE NCE UPPER
REGISTRATID;`#'IIr6. ® COUNTY
NO. DESCRIPTION OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO ds ,
PUBLIC SEWER @ $3.00 TYPE OFCkNNECTON. LENGTH'FROM
SEPTIC TANK, SEEPAGE PTT OR
PITS AND!ORDRAINFIELD @ $3.00 Y. CILRB P.L. M.1,.-TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER. CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1,00 CO.IMP.NO. V JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. - ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER,"PAI-R-9R�Ah00N HOUSE _ STATE ENCROAC�kMEN'F
SEWER OR DdSPOSA 6_STEM
@ $1.00 PERMIT NO. ,-
INDUSTP,I
WAST APPROVAL
CHAR ES
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR°S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF i g— uNEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK".,SEEP,PIT(S)
ADDRESS _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Cl DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
L$121GIATURE
LIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE —
SCRIBED RESIDER IAL PROPERTY, BACKFILL SEPTIC TANK51]
;✓� i
SEEP.PIT(S)
CESSPOOLS®.
OF PERMITTE -
�• VAIJDAnON ROBERT A.WOOD
CIG. X.o. cmm o SUPERVISING MECHANICAL ENGINEER