HomeMy Public PortalAbout9831 WENDON ST_Sewer__ DErART ' OF COUNTY ENGngEEti SEWER-SEWAGE DISPOSAL
nivisioN of svn.nzrrG Axa sAFSTY PERMIT APPLICATION
COUNTY OF LOS "GEMMS
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY C
BUILDING NEAREST
ADDRESS Rj r +Afi=?� .. CROSS ST.
LOCALITY -DISTRICT N0. SERIAL N0. PERMIT N0.
NEAREST A �(JJ/ di S
CROSS ST.
RE EIVED.BY Ready for Inspection D TEISSUED
OWNER 7.
MAIL
ADDRESS USE ZO OCCUPANCY MAP
BK PG
CITY �TjEL.NO.
CONTRACTOR , ` n C r-
r CO.IMP.NO. 1 -/
ADDRESS '� . �_ - _ a
lp _ v��Y° JOB.NO.
CITY�� � TEL.MO y� '���r�C TRUNK PERMIT NO. �--.
REGISTRATION N0. � COUNTY ROAD PERMIT NO. /
LEGAL STATE ENCROACHMENT
DESCRIPTION' LOT NO. Ole J PERMIT NO. -
BLOCK TRACT Z®f? & WASTE APPROVAL
SIZE OF LOT "¢¢a NO.OF BLDGS.
�/ NOW ON LOT CHARGES
BUE OF
I DINGS .Q erg -CONNECT NARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO o _
PUBLIC SEWER 0 $ '8:50 ' ` RECEIPT NO. DOE I 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 N0. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 - CONNECTION DATA
SEPTIC TANK
,SEEPAGE PIT OR �[ -..-- 70
PITS AND/OR DRAINFIELD 2.00 STATION g /�T DEPTH
CESSPOOL—D RYW ELL ¢ �r
SPECIAL CONDITIONS'ONLY 2.00 20� ,// flT M UPPER EFERENCE
E COJCTIO LENGTH FROM
OWNERS PERMIT $ I 00 TYPuRB M.L.TO P.L. �V
AUTHORIZATION TOTAL.FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOV DESCRIBED EXISTING APPROVALS- INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC 8EWER
SIGNED THIS... ._._... .D Y'ONEW HOUSE SEWER
-OWNER OR & CONNECT ADDITIONAL
OWNERS A ENT. -^ BUILDING ORWORK
. ..... ._. .�.:_.._.._. .
SEPTIC TANK,SEEP.PIT(S)
ADDRESS. ... . ..... ..... . _.._ .. ................................. AND/ORDRAINFIELO
1 HER ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[3 DRYWELL
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 DISPOSAI..SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE D CRI.BED ESIDENTIAL PR ERTY: BACKFILL SEPTIC TANKS
SEEP.PIT(S)I] CESSPOOLS
SIGNATURE
OF PERMITTEE... r_. `1.....
46A642D 663 1/53 �f /