HomeMy Public PortalAbout9873 WENDON ST_Sewer__ DEPARTMENT OF COUNTY ENGIlVLER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY c8 73 PERMIT APPLICATION
COUNTY OF LOS "aELEs
WILLIAM J. FOX, COUNTY ENGINEER BUILDING M
I ADDRESS - e /!
FOR APPLICANT T TO FILL IN ,' LOCALITY
BUILDING ry NEAREST /�
ADDRESS f ( r fi Fr A CROSS ST.(re Q E19�Q
LOCALITY DISTRICT N0: SERIAL NO. PERMIT NO.
NEARESTy �✓ -�+ ,� 923 9 n
CROSS ST. BEC IY BY Ready for Inspection DATE ISSUED
OWNER l/I fF �G.Ay� x v �b` L� t:�. ` 4�j3
MAIL
ADBRESS 6
USE ZONE OCCUPANCY BK MAP PG
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C014TRACTOR C0400 604--al-;N `� �'t�i �•�
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ADDRESS • i
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72-
CITY °' - �,�rr`L, TEL.N� �c^� �) �� }r /
- TRUNK PERMIT N0.
STATE
REGISTRATION'0. /� �") �J . .COUNTY ROAD PERMIT NO.
LEGALSTATE ENCROACHMENT
DESCRIPTION LOT-NO. PERMIT NO. `
BLOCK TRACT A �� WASTE APPROVAL /
SIZE OF.LOT �` 1 f NOW ON LOTS CHARGE
USE OF
BUILDINGS .1/ LC �k�'. 11r s-� CONNECTION CHARGE FEE
N0. _DESC-IPTIO.N.-.OF WORK fiEE
HOUSE SEWER CONNECTING TO y REINS URSEMENrtFEE
PUBLICSEWER 3.50 J ® RECEIPT NO. Ir DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL,SYSTEM 1.00
CONNECT ADDITIONAL.BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING DATE B
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
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 9.00 MANHOLE REFERENCE
/ UPPER
TYPEOFOONNECTION LENGTH OM
OWNERS PERMIT $ I 00 -ma- P.L. M.L.TO P.L. .r
AUTHORIZATION TOTAL FEE so
I14AVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING. APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS. .....__.....DAY OF ....____ Ig______ NEWHOUSE SEWER
rt z�._ _��y�
OWNER OR i � ;y� CONNECT ADDITIONAL
OWNERS AGEIY f �._.••__-r__: �' fi�- '•�-t � BUILDING OR WORK
f SEPTIC TANK..SEEP.PITS)
ADDRESS...:..........._......_......-....................................................... -AND/ORD RAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYW,ELL
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 AkD SEWERS. SEWAGE DISPOSA4SYSTEM
I HEREBY CERTIFY THAT ! AM PROPERLY REGISTERED
AND/OR LICENSED ASyREQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE.OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE ESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
a f� �a' SEEP.PIT(S)0 CESSPOOLS
SIGNATURE 9' �
OF PERMITTEE..:........
_.._. .._..:..r:.......__ ...--.-.._.
76A642D 603 1153