HomeMy Public PortalAbout9210 WOODRUFF AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY EN13INEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING / NEAREST
ADDRESS ' CROSS ST.
LOCALITY �^
C� DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTA
GROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNMAIL
ER ,�-
ADDRESS ��/ G i fJr USEZONE OCCUPANCY MAP
BK PG
CITY TELAO.
CONTRAC OR
CO.IMP.NO.
ADDRESS ✓ r %f '� /
` 10B.NO.
CITY / _ �+ TELAO. rC. [�* t!x'�`c
TRUNK PERMIT N0.
t STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO. ✓� I
.°
DESCRAPTION LOT STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT �iJ'k / INDUSTRIAL
WASTE APPROVAL
NLD
SIZE OF LOT .5-4 X O.OF/ NOWOO. LOTGS.
CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER_ @ $ 3.50 RECEIPT N0. I DATE I BY
HOUSE SEWER
CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. I DATE IBV
ALTER OR REPAIR EXISTING
_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 i f ` DEPTH
CESSPOOL—DRYWELL I f
SPECIAL CONDITIONS ONLY 2.00—� ?- MANHOLE REFERENCE� lg" `;' UPPER LOWER
_ TYPE OF CONNECTION LENGTH FROM
OWNERS _PERMIT $ 1 I 00 Y. CURB P.L. —M.L.TO P.L.
AUTHORIZATION I TOTAL. FEE I -
i HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
i L ...._....193--� NEW HOUSE SEWER G�•
SIGNED THIS-.....�_///jL1.._DAY OF._, � .�._....__ _.
OWNER OR r f �✓ CONNECT ADDITIONAL
OM?7ERS AGENT....--...:_......_4................___---_._-----..-.----......._.
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS... _l`l.....__... �._.._lL�'.. ............. . :................•-•-•--- AND/OR DRAINFIELD
L�
1 HEREBY ACKNOWLEDGE THAT i HAVER THIS APPLI- CESSPOOL I] DRYWELL I]
CATION AND STATE THAT THE ABOVE IS CORRECT t.ND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THATRE AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT t AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[] CESSPOOLS ��r
r
OF PERMITTEE - t - tC� rr%'�. --•--
76A642D 663 1/53