HomeMy Public PortalAbout9819 WENDON ST_Sewer__ DF,PART3IENT OF COUNTY EWGI.'F,FR SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
- COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING f
ADDRESS
FOR APPLICANT TO FILL IN '- LOCALITY
BUILDING G NEAREST
ADORE SS
P� I CROSS ST.
LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST``— r , � S
CROSS STS,yI 01 Lr .A+r RE EIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE I OCCUPANCY BK MAP t'G
ADDRESS
CITY TEL.NO. ' ! d. 5Vj
CONTRACT&IZf yq Al 7 1 C 4L
C6rF f 1`,` CO.IMP.N0.
ADDRES /
r • JOB.
CITY TEL.NO. . b'6l ,b...
TRUNK PERMIT N0. '
REGISTRATION NO. ,moi , COUNTY ROAD PERMIT NO. 76 71 C>.:
LEGAL ff
[
DESCRIPTION LOT NO.
1 7; L• . F STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 4: INDUSTRIAL —
WASTE APPROVAL
SIZE OF LOT - ° NO.OF NOW ON LOTS CHARGES
USE OF '
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO �a
PUBLICSEWER @ $ 3.50 <_, RECEIPT NO. ATE � BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR_DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT Oft
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ! MANHOLE REFERENCE
UPPER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P-l..-- M.L.TO P.L.
AUTHORIZATION i TOTAL FEE �I
CONTRACTORHAVE
TO CONNECT DATE THEED TOABOVE DESCRIBED IEXISTIN4 ED APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS......._.._...._:.DAY OF..... 19-.- NEW 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 APPLI. CESSPOOL E] DRYWELL I]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDONHOUSE AND STATE OF CALIFORNIA OR THAT t AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)� CESSPOOLS f„
SIGNATURE
OFPERMITTEE--•--------------------------._.--------......................---------- i
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