HomeMy Public PortalAbout9848 WENDON ST_Sewer__ ,24650 INSERT'S
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76fiA6+ APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ABDDRESSUILDING
IOH1N A. LAMBIE. County Enggin®oY
WILLIAM A. JENSEN. Supt of Building OCALITY
NEAREST
FOR APPLICANT TQ FILL IN CROSS ST.
LEGAL �{
DESCRIPTION LOT NO. OWNER ]- -
BU'LD'NG
BLOCK TRACT ± * �! ADDRESSRAI L
}NO.OF BLDGS, -SIZE OF LOT NOW ON LOT X CMTY .r:: f_TEL. N0.
USDISTRICT NO.A GROUP MAP ?ROCESSED BY
$ _ y ',A` 'r` ' _�.
BK PG
CONTRACTOR
ADDREss CONNECTION DATA
Crr _ TEL.No.
STATION DEPTH
:.
ti -STATE 'MANHOLE REFERENCE
REGISTRATION NO. .,;;� COUNTY / LOWER
NO.� DESCRIPTION OF WORK FEE ----.
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $3-00 TYP LsC(1NNFCTION LENGTH FROM
SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR GRAINFIELD @ $3.00 _
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00 _
—I HOUSE SEWER CONNECTING TO I `� _ P.C.NO.PRIVATE DI pOSAi SYSTEM @ S1.00 CO.HMP. NO, W+� g ,,I. JOB NO. ye
CONNECT ADDITIONAL BLDG.OR I 'TRUNK PERMIT N0, ROAD PERMIT NO. % O0
_ WORK TO HOUSE @ SEWER $1.00
ALTER. REPAIR OR ABANDON HOUSE I STATE ENCROACHMENT pG
SEWER OR DISPOSAL SYSTEM @ $1.00 PF,RMIT N0, O
INDUSTRIAL
WASTE APPROVAL W
_ CHARGES
OVMER'S PERMIT E OO CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE ti." REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER. ��r�--�^^ •T--
SIGNED THIS SAY OF__x; t9J NEW HOUSE SEWER i
OWNER DR CONNECT ADDITIONAL
OWNERS AGEN' BUILDING OR WORK _
ADDRESS .SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 BEREA ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
A.ND STATE THAT THE ABOVE 15 CORRE?CT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND./OR DISCONNECT PLUG AND
LICE{S:,- AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT ,,I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDER I Lt.PROPERT)k BACKFILL SEPTIC TANKS ❑
SIGNATURE °y7'; ? a SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITTEE..+'. "��ik'
" VALIDATION--__..., ROBERT A. WOOD
CK. M.o. CASR f SUPERVISING MECHANICAL ENGINEER