HomeMy Public PortalAbout9872 WENDON ST_Sewer__ 6A 6421) - CE808 - 4/73APPLIC ATION IDR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS dil
LO AL
NEAREST000
FOR APPLICANT TO FILL IN CROSS
--vEc
DESCR
_OWNER
MAIL
BLOCK TR.CT ADDRESS / Y'Z�4- If- 4�C-j
SIZE FNBLDGS. CITY /lyTEL. 140.
_—OF LOT 4--lo "I LOT ED BY
USE OF DISTRICT No. MAP FS S
GROUP
BUILDINGS OUPI SK -N,
P
CONTRACTOR3
ADDRESS -CONMCTION DATA
ATfON DEPTH
crrY72 TEL. NO.
—UPPER
STATE LIC N14OLE REFERENCE LOWER
CLASS LICENSE, NO;_ SS LENGTH FROM
FLf��C F
N
No. — DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.To P.L.
H&6i`SESFE—WER CONNECTING TO
PUBLIC
SEWER 0 $7.00 PC N
0'
�R Co.IMP.NO. JOB No.
SEPTIC TANK.SEEPAGE PIT 0
_PITS�AND/OR DRAINFIELD 510.00
-NE- TRUNK PERMIT NO. ROADCONNECTING PERMIT NO.
PRIVATE $3.00
_IIMSfOSA�SYSTEM RECORD.INSTR� DATE >-
-C-0-NNECT AFT?- - _iw�bjf--- AFFIDAVIT WAIVER CASEMENT c�
WORK TO Hous $3.00 C)
HOUSE IE
_ _VVER
-6-Vf�-R-F-L SEEPAGE PIT,DRAINFIFLD
EXTN..CE5SPOOL.DRY WELL. 0 $5,00 HWY,OR ST.WIDENING
-G—E
S ---- CD
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM --NV $3.00 STATE ENCROACHMENT
T WMANHOLE 0 $7.00
PERMIT NO. _ !��- c-
--- INDUSTRIAL CA)
WASTE APPROVAL
I - CHARGES
OWNER'S PERMIT $1 31 00 CHARGE FEE
CONNECTION C
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING DATE INSPECTOR'S SIGNATURE Las
TO THE PUBLIC SEWER. APPROVALS
SIGNED THIS DAY OF19—
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS.-_- SEPTIC TANK.SEEP,PIT(S)
I
HERESY ACKNOWLEDGE THAT f HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND
STATE THAT THE ABOVE 16 LY
CORRECT AND AGREE TO COMP
WITH ALL COUNTY
ORDINANCES AND STATE LAWS REGULATING CESSPOOL [I DRYWELL ❑
PLUMBING
ING AND SEWERS.
HERECERTIFYR THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED ENSED 'LOS ANGLES CO STA OF SEWAGE DISPOSAL SYSTEM
NO
AS REOU"t"D By HE LEGAtjOVVNEFU'llA�= INTEND TO
CALAI'MRNIA OR THA I A DISCONNECT PLUG AND
E
RESIDE IN CIRISE/!�-�,.D NTIA�*i- ABANDON HOUSE SEWER
SIGNATURE ❑
TTTEE BACKFILL SEPTIC TANKS
OF SEEP.PITS) [I CESSPOOLS ❑
VALIDATION CK. M.0. CASH
3 1 5 r2'kUt �7 0 6.0
DEPARTAIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
r COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING
4,
ADDRESS f--I f NEAREST
�/ CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST / A S
CROSS ST. 'C / , _ s .( _
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER J-p
MAIL LJ USE ZONE OCCUPANCY MAP
ADDRESS � C I BK PG
CITY
CONTRACTOR C,
_ CO.IMP.NO.
ADDRESS / L JOB NO. �-
CITY1 TELAO. �- O TRUNK PERMIT NO.
REGISTRATION NO. STATE
�! COUNTY ROAD PERMIT NO.
LEGAL fie►
DESCRIPTION LOT NO. „fJ STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT L/ N0.OF BLDGS.
,C X 141 NOW ON LOT / CHARGES
USE OF h �—
BUILDINGS L�IC e-Z— ����� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE R TI
SEWECONNECNG REIMBURSEMENT FEE
TO
PUBLIC SEWER @ $ 3.50 f z RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO• DATE I BY
SEWER OR DISPOSAL SYSTEM_ 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH to
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT 1 00 Y. CUP,B P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE I f"L
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUpLIC SEWER.
SIGNED THIS......F...:. .._..DAY OF_. .. f!-4..__._...._.....I9_�j NEW HOUSE SEWEROWNER OR
CONNECT ADDITIONAL
OWNERS AGE :....................... —BU ILDINGORWORK
�� SEPTIC TANK,SEEP.PIT(S)
ADDRESS- ...____.. 145.._.5.___._..... AND/OR DRAINFIELD
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL ElDRYWELL
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
1 HEREBY CERTIFY THAT 1 AM�PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED B. LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I.AM THE LEGAL OWN-
ER OF THE ABOVE SCRI D T�L PRO R'aY�. BACKFILL SEPTIC TANKS E]
SIGNATURE �c
�Y l SEEP.PIT(S)E] CESSPOOLS 0
OF PERMITTEE---_. _DL.1 1-----------------------------------
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