HomeMy Public PortalAbout9861 WENDON ST_Sewer__ ES08 D 1f-57
CAPPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINGS �q
JOHN A. LAMBIE, County Engineer ADDRESS fG 4 i' / ✓ +
CASSATT D. GRIFFIN, Supt of Building LOCALITY i�"
FOR APPLICANT TO FILL IN NEAREST
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FNO. DESCRIPTION
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PTION LOT N0. ns ° / 4 - tw+:t,d le�a �Y OWNER a tr y' y �e.'"
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: 7RAGT ' k / «s `MAILADDRESSNO.OFBLDGS.LOT NOW ON LOT' CITY TEL.NO..rNGS - J�✓ _ D,y_, fiDISTRICT NO. GROUP HAP
CTOR 'BKjG
SS tf 'p5if , �' d: � ; CONNECTION DATA� ya . ,7 TEL.NO, �pr . ®;1 STATION f- - DEPTH STATE MANHOLE REFERENCE ✓ . YII PERRATION NO. i-'+i .{ = ' COUNTY DESCRIPTIONOF WORK ,EI.DWEftOUSE SEWER CONNECTING TOPUBLIC SEWER +- :�a� r:'EPTIC TANK,SEEPAGE PIT OR TYPE OF CO3^1NEGTION LENGTH FROM
PIT'S AND/OR DRAINFIELD @ $3.00 Y. URP.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD .�.._
EXTN.,CESSPOOL,DRYWELL.,MANHOLE {D $2.00
HORSE SEWER CONNECTING TO
P.C.N0.
PRIVATE DISPOSAL SYSTEM Q-) $1.00 CO. IMP.NO. �'. � - i JOB No.
CONNECT ADDITIONAL BLDG.OR - �>
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT NO. -
ALTER,REPAIR OR ABANDON HOUSE -_ - -
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT_NO. _
_ INDUSTRIAL
WPR
'HASTE APPROVAL
�x� CHARGES
OWNER'S PERMIT 3 -_��-��-000- CONNECTION CHARGE FEE
rAUUTHORIZATION TOTAL FEE i ;v REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- — --_- -- - -
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE iINSPECTOR'SSIGNATURE
TO THE PUBLICO SES
SIGNED THIS DAY OF—_", 19NEW HDus£SEWER _
OWNER OR j!, h y J ; CONNECT ADDITIONAL _ --
OWNERSAGEN7 /r1f c , s , ( F�_.._!��_4=.;:.i� BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
--- AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
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ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
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HERY CERTIFY THAT I AM PROPERLY REG-ISTERED AND/OR SEWAGE DISPOSAL SYSTEM -
LICENSED AS REQUIRED BY LOS ANGELES 'CTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT,,f AM THE LEGAL .BV N T OF TRE' ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT� PROPERTY ," r f°' BACKFILL SEPTIC TANKS ❑ f T
SIGNATURE SEEP. PIT(S) 0 CESSPOOLS
OF PERMI
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g VALIDATION ROBERT A. WOOD
CK. M.Q. CASH SUPERVISING MECHANICAL ENGINEER