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HomeMy Public PortalAbout9824 WENDON ST_Sewer__ S \ ` '6A,64aD --�E808-t0-7t APPLICATION FO PE MIT t COUNTY OF LOS ANGELES SEWER-SEWAGE GE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION r�R...NEAREST UILDING 'n✓1z5/Ef DDRESS .r OCALITY FOR APPLICANT TO FILL IN ST. • (• � LEGAL / J DESCRIPTION LOT NO _ OWNER ( 'Z �// MAIL BLOCK- TRACT �„�{,p _ ADDRESS dj` NO. OF==OFAABLDG G��S. '�3 � „ti `3 - ��•. SIZE OF LOT NOW ON LOT CITY . `° TEL. NO, USE OF BUILDINGS D151"R ICT NO. GROUP "AAP PROCESSED 8Y B K PS CONTRACTOR ,�' J"Y (�✓ ` f/ ADDRESS G�.�.d L.',.-d ` .✓ iCONNECTI DATA _ CITY _ a ��—A TEL. NO. �� iG �„� STATION /} DEPTH STATE .8 ,[r' �� ./' LIC , MANHOLE.REFERENCE.4y "jt Q �'f� LOWER LICENSE NO. �Z I CLASS I TTT"" NO. DESCRIPTION OF WORK FEE TYPE OF TION - LENGTH FROM HOUSE SEWER CONNECTING TO ® Y. CUR P.L. M.L.TO P.L. PUBLIC SEWER 0 $7.00 SEPTIC TANK.SEEPAGE PIT OR �� P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO. IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. Q PRIVATE DISPOSAL SYSTEM @ $3,00 0 CONNECT ADDITIONAL BLDG.OR ECORD. INSTR.NO. DATE u WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE IT.DRAINFIELD _ ce E XT N.,CESSPOOL.ORY WELL. $5,00 0 HWY.OR ST.WIDENING ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $3.00 _ - - W S _ ,- TATE ENCROACHMENT MANHOLE @ $7.00 PERMIT NO. — ------------ INDUSTRIAL N WASTE APPROVAL z CHARGES OWNER'S PERMIT $ 3 00. AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �^^ TO THE PUBLIC SEWER. / LS- APPROVADATE 1, ECTOR'S IGNATURE SIGNED THIS�.,DAY OF ! `�"'' - 19 -- OWNER ORI >1 •,d° ,,gq,��.5���gq NEW HOUSE SEWER ''y, OWNERS AGENT l�.,� ', I ,/ ------- CONNECTADDITIONAL ADDRESS Zh. .�• ,+ BUILDING OR WORK 1 r•e. ._ —_ SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY — WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS. CESSPOOL El DRV WELL 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF S EWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND �? RESIDE IN, THE ABOV.VESCRIBF• RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER r' S10F PERMITTEE_ 'j"...�- y __-_- __ - ___ BACKFILL SEPTIC TANKSGNATURE ❑ /� ��' .� SEEP,PIT IS ❑.. -CESSPOOLS ❑ VALIDATION CK, ' M•0• CASH V