HomeMy Public PortalAbout9222 WOODRUFF AVE_Sewer__ APPLICATION FOR PERMIT-
COUNTY OF LOS ANGELES SEWED-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �+
TCHN A. LAM'BIE, County En•ineer ADDRESS 4
WILLIAM A. JENSEN, Supt of Iguilding
LOCALITY A 3., i'3 }' t/
FOR APPLICANT TOM IN CROSS 5T:
TEGAIOEyy
TCR P"fdOPV uT NO -. OWNER v }
MAIL
BLOCK TRACT �' ADDRESS
NO. OF BL'DGS.
SIZE OF LOT �� NOW ON LOT CITY TEL. NO.
USE OF
I.WILDI.NGS DISTRICT NO. GROUP MAP PROCESSED BY
BK
CONTRACTOR
J e✓;'( fid""' �'�,'�:Y� 4.-�i_ ___ __
ADDREss y _________._ ._ —_CONNECTION DATA
"""yyy��, STG."IO�e DEPTH
CITY' TEL_NO., G� Y ,7y^ _
El ¢-L MANHOLE Rc, .=wF hrc -
REGI STRATIO 7 NO .e�/{��, r� uCTO<UTNTY 'r l 'L "-
NO. 1- OESCRI PT1ON OF WORK FEE. --_--.-. - - I �. _.
---a. -._ .` TYFL OF•^_.O`C3h F.,T ION t_ENS','tH FR?.11
H 0U SE SLW ER f.ONNECTING TO i'.-� - Y. 'Cu RH P L, M.L TO P i, Ia.
PUBLIC S DYER Q $5.00 f f -.-._. -- ___ P.C.NO.
1 — — T
SEPTIC TANK,SEEPAGE PIT OR ---_ _r._- -
PITS AND;OR DRAINF[ELD Ca' $10.0U co, imp.NO -.--- - .108 NO. -. -_--
-_- NOUS£SEWER CONNECTING
TO TRUNK PERMIT NO. ROAD PERMIT NO,
I PRIVATE DISPOSAL SYSTEM @ $3.00 1 O..
_ . . __.. . I ___
CONNECT ADDITIONAL 6LDG OR __—.,— AE FIDAVIT I WA1NEq CAS'EML rvY RECORD. EN5_7R NO DATE
WORKTO HOUSE SEWER @ $3.00 i
___ .__ _.
OV ERF'GCJW S£EPAG£FIT,6RA1NrIELD
- I E'(TN.:CESSPOOL,DRY W":L L,MA NiiOLE @ '3a.00 y
..____.. -_. . __ --__. ______ HWY,OR ST.WIDENING L
ALTER.REPAIR OR ABANDON rTCUSE -
.
__SEA'ER OR D15P05 AL SYSTEM � $3.60 _ _ - STATE E41-ROACH MEN7
..._ PERMIT NO.
WASTE APPROVAL.
OWNER°S PELtMIT $ 2'- CHARGES
00 -._..—.—._. ___— _ _—.
._._---_.._ CONNECTION CHARGE'.FEE
AUTHORIZATION TOTAL. FEE ------------------- ----- - ---- -
i HAVE AT T HIS DATE A-CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR 'TO CONNECT THE :ABOVE DESCRIBED EXISTNG DWELLING ------- --/�-gyp --�— —r-- ----- - --- --- ----
O iE PUBLICSE y^/ R»- APPROVALS' DATE I INSPECTOR S SIGNATURE
SiGNE... TNtS .- DAY OFs.'.°
OWNER 0;4 ? NEW HOUSE SEWER
OWNERS AC±ENI
r�.._ -
ONNEC T ADDITIONAL I
BUILDING OR WORK
AND/OR
TANK,SEEP,PIT(S) J
I HF Rr-BY A KNOW LEDGE THAT I HAVE, READ THIS Pkl C,aSION '
AND/t9R DRAlNFtELp
AND TAT.:: THAT THE ABOVE IS CORRECT AND AGREETO COMPLY - - --.-J.-------- - ----
Wlr' 4 A L COUNT'/ ORDINANCES AND STATE. LAWS REGULA'T'ING
PLUMBING AND SEWERS. CESSPOOL ,.,] DR
YWELL ❑.
1 i EHEBY :c.RTiFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR j
LICENSED AS REQUIRED BY :.OS ANGLES COUNTY .AND STATE OF" SEWAGE DISPOSAL SYSTEM i 1
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO -"'-- - - "-- � "-�-'----}—
DiSCONNECT PLUG AND I
RE
SIL N, THE ASOV.IK DFS..Al E -I SIDEN IAL PROPERTY. ABANDON HOUSE ,WER
OF .-ERMITTEE x' f - _ BACKFILL SEPTIC TANKS ❑ '-�I
'"-_-- - - - -- SEEP,PITIS) `] CESSPOOLS
-.,;VALIDATION R08ERT A. WOOD
'�
CK. M.O. CASH
SUPERVISING', MECHANICAL ENGINEER
' i .