HomeMy Public PortalAbout9405-9407 WOODRUFF AVE_Sewer__ 7SA6420
5 a E-663 I 1-55 APPLICATION FOR PERMIT 1 .
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBfE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
�EAREST
FOR APPLICANT TO FILL IN CROSS-ST.
LEGAL
D OWNER
DESCRIPTION LOT NO.
_Y 3�
BLOCK TRACT MAIL ADDRESS
s,4 I
I -----
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUTLDINGS DISTRICT No. GROUP BK MAP PG
CONTRACTOR
CONNECTION DATA
ADDRESS
CITY i TEL. NO..__ __STATION
MANHOLE REFERENCE UPPER
STATE
REGISTRATION NO, COUNTY
DESCRIPTION OF WORK FEE
TYPE OF' CONNEGTiON LENGTH
HOUSE SEWER CONNECTING TO I Y.
CURB P.L. M.LPI BLICSEWER @ $3.50 ' _
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $3,00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO NO.
EXTN.,CESSPOOL,DRYW E L L,MMO LE(al $2.00 CO. IMP. NO, 1068 NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM $1,00 R,�, PE TRUNK PERMIT NO, RMI NO.
CONNECT ADDITIONAL BLDG,OR STATE ENCROACH
WORK 70 Oa $1,00 PERMIT NO,
I ALTER, HOUSE
5EWER INDUSTRIAL
1_ S 1�00WASTE APPROk L
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO _1 HE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THISDAYCONNECT ADDITIONAL
OWNER OR _BUILDING OR WORK
OWNERS AGENT
SEPTIC TANK,SEEP,PIT(S)
ADDRESS-- AND/OR DRAINNELD
AND STATE T HAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL DRYWELLO
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEIVERS. SEWAGE_DISPOSALSYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR -
DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON
CAL;FORNIA OR THAT I AM THE LEGAL OWNER OF TH.E ABOVE HOUSE_SEWER_ _1
DESCRIBED RESIDENTIAL PROPLRTY, BACKFILL SEPTIC TANKS 0
SEEP.PIT(s) DCES3POOLS 0
SIGNATURE
OF PERMITTEE
a
iOHN A. LAMBIE.COUNTY ENGINEER VALID�T ROBERT A. WOOD,CHIEF PLEG. INSPECTOR
CK, M.
t
I C
I o3 2 jUL 2 9 10 A
LV
76AS42
5 E-6D 63 11-55 APPLICATION FOR PERMIT
DIVISION GF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer I
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER
N
B CASSATT D. GRIFFIN, SUP'T Or BUILDINGLOCALITY
NEAREST
FOR APPLICANT TO,FILL,IN ROSS ST
LEGAL
ESCRIPTIR NO- OWNER
_ OT
0-
71F
MAIL
BLOCK 7-OACT AD
=L41—
NO,OF BLDGS.
SIZE OF LOT NOW ON LOT TEL. NO.
USE OF
BUILDINGS i DISTRICT NO. GROUP MAP
BK P 1_3
CONTRACTOR j,
ADDRESS CONNECTION DATA
DEPTH _
CITY TEL NO STATION-.
MANHOLE REFERENCE
STATE
LOWER
REGISTRATION NO. COUNTY
NO. i DESCRFP�10WOF 140AK FEE
TYPE OF CONNECTION LENGTH FROM
HOUSE S
EWER CONNECTING TO Y. CURB P.L. M.L. 'TO P.L.
PUBLIC SEWE-R SEP _i� _ @ St 3.50!
TICCIA T 6R
PIT$AND/OR DRAINFIELD C@ $3.001
OVERFLOW SEEPAGE PIT,DRAINFIELD P, C, NO.
CXTN.,C,ISSPOOL,DRYWELL,MAN.-OLE Ca, $21001 CO. IMP, NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM $1,Do I RUNK PERMIT NO. ROAD PERMIT NO.
cbNNicf ADDITIONAL BUZ OR I STATE ENCROACHMENT
WORK TO HOUSES WER rJ s 1.00
PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
NDUStRIAL
WASTE APPROVAL
CHARGES .
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE �4z
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCON-
APPROVALS I DATE: INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC Srlr"ef
z NEW HOUSE SEWER
SIGNED THi DAY OF—& L
CONNECT ADDITIONAL
OWNER OR BUIL iNG OR WORK
OWNERS AGENT��—_,��
SEPTIC TANK,SEEP
1 HE- THAT 1 Hj�
REHY '.ACKNOWLEDGE gREAD THIS APPLICATION CESSPOOLFj DRYWELLD
- , -REE
AND STATE THAT THE ABOVE IS COO , AND AG TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAINS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANC/
OR DISCONNECT PLUG AND
LiCENSED AS REQUIRED BY LOS ANGELES COUNTY AND S3ATE
ATE OF ABANDON HOUSE SEWER
CALIFORNIA OROF THE ABOVE
, THAT I AM THE LEGAL OWNE8
DE I R BJW� RE'' ENT;IKI PROPERT BACKFILL SEPTIC TANKS 0
�
SEEP.PIT fS) El CESSPOOLS Ij
Of/ptRMIT-rEe
I — ,�mffd
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLI3G. INSPECTOR
CK. 9S.Q. CASH
tg
A t,