HomeMy Public PortalAbout9860 WENDON ST_Sewer__ a,E-673
SfiH 75.$3 APPLICATION FOR PERMIT 1
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DIVISION C:° .>:aILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
vi CASSATTD. GRIFFIN, SUP'T OF BUILDING '_OCALITY -
FOR APPLICANT TO FILL IN SEAR ST
CROSS ST., • .:.�_ ..�., s.. - -
LEGAL OWNER -
DESCRIPTION LOT N0. _ - _
f /
BLOCK TRACT - .si
ADDRESS
NO. Of BLDGS. '--_--- CITY _- ------ TEL. NO.
SIZE.OF LOT NOW ON LOT
--- --'— �----"ter-� ---'".--....----
USE OF _ DISTRICT NO. '• GROUP MAP
B U.ILDINGS:� _
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- BK PG
CONTRACTOR
ADDRESS ;. --T -__—. CONNECTION DATA
CITY - TEL N0, _STATION_ i - ", .�'___. DEPTH -
-- a--%--= ---=�'----- --- – --- -- - MANHOLE REFERENCE {' Z' UPPER
_
E ]--STATE
REGISTRATION NO. - ❑ COUNTY
No. DESCRIPTION OF WORK- FEE- - - - ----
HOUSE SEWER CONNECTING TO T.- i TYPE OF ,rCTION LENGTH FROM
.:'i ..* Y. 'CURL P,L. M.L.TO P.L. `
PUBLIC SEWER
�-
' SEPTIC TANK,_SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Ca $I Do - � --- --
OVERFLOW SEEPAGE PIT DRAINFIELD Ji __- 1 P. C. NO. — -
EXTh CESSPOOL,DRYW ELL,MA N HOLE Z.Op. LCOIMP. NO JOB N0, _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM co` $1.00 I RUNK PERMIT No. ROAD PERMIT NO. f i ¢
! CONNECT ADDITIONAL BLQG.OR i i. - - STATE ENCROACHMENT –
WORK TO HOUSE SEWER Ix $.1.00PERMIT NO,
-- -- --- — --- - _ _'_ --- ------- -----.-_—_.T--- --
–� ALTER,REPA R OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM. (.i $1.00 � __ WASTE APPROVAL
- CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 3
— — —._
-- – REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS I DATE J1 JSP=:CTOn".S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - —--_` —� -- --j --- -- -_--
TO THE PUBLIC SEWER. NEW HOUSE SEWER_
SIGNED THIS DAY OF 19- CONNECT ADDITIONAL
OWNER OR _BUILDING OR WOR-K-----,-------_-------- —
OWNERS AGENT :�-.� SEPTIC TANK,SEEP PITS)
ADDRESS_ ND/OR DRAINFIELD _
1 HEREBY ACKNOWLEDGE )FT1 HAVE READ THIS APPLICATION CESSPOOL[] DRYWELLE]
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR I
PLUMBING AND SEWERS, _SEWAGE DISPOSAL SYSTEM _
I HEREBY CE. 4FY THAT I AM PROPERLY REGISTERED AND/OR DISCONNE.C'I'PLUG AND —�-------
LICENSED AS REQUIRED BY LOS ANGELES COUNTY,A.ND STATE OF ABANDON HO PLUUSE G AND I _
CALCF'ORNIA OR TH47 AM THF LE;u'AL OWNER Or THE ABOVE.-
DESCR13k'`DR,E'S1DL-NTIAI�-tHV-F RSY -BACKFILL SEPTIC TANKS[] ---�---- ..
SIGN; UQ.E`4' d.:': l'"�; - - 5EEP.PIT(S)_L_ICESSPOOLS
I'1 OF PERMITTEE
fOHN A. LAMBIE, COUNTY I=NGINEER VALIDATION,F._M ROBERT A. WOOD,CHIEF PLBG. INSPECTOR
CK. m. 01 LASH