HomeMy Public PortalAbout9843 WENDON ST_Sewer__ &E-663 3.5E FOR 8 APPLICATION R PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDIDDREG
WM.J.FOX. COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT of BUILDINGS LOCALITY
NEAREST ---
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL ,._. o - —
DESCRIPTION LOT NO. f' OWNER •. d f ! r '
BLOCK / TRACT ' i - MAIL
ADDRESS
NO. OF BLDGS.
SIZE OF LOT 0N-14OW ON LOT CITY � �""�.-,o �kj � �n 1 `. �. - ° `
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USE OF {
BUILDINGS_ -;:; k _-_ _ DISTRICT NO. I GROUP 1 MAP
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CONTRACTOR
ADDRESS_ .�, ,� � -� f CONNECTION DATA
_CITY I� -.o - _ �...x� STATION DEPTH "'•
STATE MANHOLE REFERENCE _
REGISTRATION NO. - r COUNTY _.— -� - ----- —LOW ER
NO. DESCRIPTION OF WORK FEE �4
- - -- - -- -' TYPE - t�uiECTION LENGTK FROM
u" HODS£SEVY ER CONNECTING TO Y^— CURS F.L fit L_TO P _
UB
HOUSE SEW-E1? CONNECTING TO�— --
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR — - P C NO.
_ WORK TO HOUSE SEWER 1.00 --co.-IMP. -N0. � JOB NO.
1 ALTER OR REPAIR EXISTING - -- -. - --- -
SEV{Eft_OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
D!SCONAEoG ANil ABA lDON SEWER _--- - STATE ENCROACHMENT --��_----_----_---
AND/OR DISPOSAL SYSTEM, _ 1,00 PERMIT NO,
SEPI C TAN SE FAGS PIT CR
PITS ANDIOR DRAINFIELD - .00 `:NDLSTRIAL
CESSPOOL DRYWELL
'--' WASTE APPROVAL
SPECIAL CONDITIONS ONLY - 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERIMIT 11 00
AUTHORIZATION REIMBURSEMENT FEE
I HAVE THIS DATE CON-RACTED WITH THE HEREIN NAMED CON- ��p c
7RACTCR TO CONNECT THF. ABOVE DESCRIBED EXISTING DWF LINO APPRO ALS D.TE Jt P-C- O:R S51GNATURE-
TO THE PUBLIC SE. FRI
." .. ` NEW HOU=SE SFVIER
SIGNED THIS---+s- =--D�AY _ONNEC._T__ADDITIONAL
OWNER OREBUILDING OPWORKOWNERS AGENT-
SEPTIC
'
TANK,SEEP, PIT(S)
ADDRESS_._, t-'.�_._.__$�---.. -----�_.- — --- --_ _`AND/OR DRA1_NFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL?E DRYW_LL.Q
AND STATE THAT THE ABOVE iS CORP,ECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LTER,REPAIR,SEWER OR
-A
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM.
d HEREBY CERTIFY THAT I AM PROPERLY REGISTERED"AND/OR '---'- --'"---"------ - '�
Li LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE WB,ANDON HOUSE SF4fFR _ _
DESCRIBED RESIDENTIAL yPROPERTY BACKFILL SEPTIC TANKS[a'
SEEP, P!T{S) (� GESSP00L'S{�i._ e
SIGNATURE '
-0F PERMITTEE `:- _ ti -_..
WILLIAM J.FOX,COUNTY ENGINEER VAL ATION R,A.WOOD. CHIEF FPLSG. 1NSFECTOR
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