HomeMy Public PortalAbout9866 WENDON ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
ti DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS ___ CROSS ST,
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. cc
NEAREST —` - ------ A J
CROSS ST. -
RECEIVED BY Ready for Inspectlon DATE ISSUED
OWNER
MAIL USEZONE OCCUPANCY MAP
-ADDRESS _ I � BK PG
CITY TEL.NO.
CONTRACTOR
CO.IMP.NO.
ADDRESS JOB.N0.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. PICOUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
----- WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
I HOUSE SEWER CONNECTING TO --
PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRsVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. I DATE I BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM _ 1.00r CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR I
PITS AND/ORDRAINFIELD _ 2.00 _ STATION DEPTH
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE'
UPPER_ LviVtii-
_ TYPE OF CONNECTION LENGTH FROM
OWNERS _PERMIT � 1 00
Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEF -- - -
I HAVE_ THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTCR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------------------DAY OF.......-........................ - 19- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT----._..-_.-,_.------------ - BU!LDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS---_----------------- ................. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] DRYWELL El
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 DISPOSAL SYSTEM
I HEREBY CERTIFY THAT ' AM PROPERLY REGISTERED
AND,/ DISCONNECT PLUG AND
OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON T USE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTICTANKSr]
SIGNATURE SEEP.PIT(S)D CESSPOOLS[]
OF PERMITTEE. - --- - -- -------.......
i