HomeMy Public PortalAbout9414 WOODRUFF AVE_Sewer__ :E8°810-63 APPLICATION OR PERM T - �
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
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.DING :'
JOHN A. LAMBIE, County Engineer ADDRss
WILLIAM A. JENSEN, Supt of Building °
LOCAL T �aZ• 3.-'
NEAREST _—_J.— ✓ - ___ _ _— _.—
FOR APPLICANT TO FILL IN GROSS 5r
LEG/•L > �P•
DESCPIF,ION LUT NO.
OWNER
[) g) MAI L
BLOCK TRACT dam. ✓ ADDR.E6S �'fYJ._ C ___-- -_-_ ----
NC. BLOGS
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SIZE OF LOT _ NOON LOT _ - ___ _ ___._
JSE O�• DISTRICT NO. GROUP MAP PROCESSED nY
BUILDINGS Ia .:- 1 BK PG
CO NT RAC7
ADDRESS CON EC IO ATA
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-y/� STATrONDF PTH
CITY _- TEL NO.
a TATE MANHOiE REFERENCE PER
REGISTRATION NO > ' L! COUNTY _
_ -Cl - _- _ y 5�
NO.I SCRIPTION OF 440RK FEE TYPE OFC ON LENGTH FROM
H.OUSE SEWER CONNECTING 7D - --- K y—P.L:_- ._M.L.TO P.L.-._
P 7BL.0 SFWFF2 --_@
gCO IMP.NO JOB.NO
Fp7 C?ANK PIT OR EEPA(,F � ),
j PITS AND OR DRAINFIELD R $10.00 -
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE 71SPOSA.L SYSTEM Q 53.00
-- � Y
Y
! COMP{ECT ADD!TONAL SLOG OR AFFIDAVIT wALVEft ERSEMEtit RECORD.INS.R NO. DATE
WORK TO HOUSE SEWER $3.00
qV ERF LOW SE.EPA�=E-.:7,DRAINF'(ELD
EX N.,CESSPOOL,DRYWFL a MANHOLE @ $5.00
.-_--}��------- _ -_-_ __ .----E HWY.OR ST.WIDENING I RLTER,RF:pA1R OR AB Ah D!�N F{OUSE 1 -1_ tfi)
.._..�I SEWER OR DISPOSAL .S?EA1 $8.00 .-- _—
-__..__-._ ___-�____ 5TATEENCROACH MEN'T
j I PERMIT NO.
r
iNOUSTRIAL
j WASTE APPROVAL
CHARGES
OWNER`S PERMIT s' oo — — -- -- ------- --
+g,,
may - ,----
AUThORIZATION TOTAL FEE CONNECTION GHAHCR FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RC_�MBU RSEM ENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELL[NG --- --�r-4—C— --'-j- --- -----' -
TO THE PU BLic SEWER. APPROVALS ALS �I DATE INaPEC?'OR 5 SkGNA: JRG
SIGNED THIS DAY OF--
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F 19—
j.�
OWNER OR. ��s, //,�,,,.. '� tt NEW HOUSE ER 1. --J_
OW NERS AGEN� ` .+ S _..
CONF7E T ADLITIQNAL
`f�q BJILGING OR WORM
.ADDRESS-
-*- -- 5FPTY< TANK,.SEEP PIT(5)
I HF-RFS
CSFSY ACKNOWL€DTF{AT I HAVE RE IS APPLICATION AND/OR RAiNFtELD
AND STATE THAT 1'HE ABOVE I5 CORRECT AND AGREE To COMPLY ------ -- - - ;- -- -- ---- -------
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSa00L 0 DRYWELL
1 HEFAE BY CERTIFY T AM. PROPERLY Ed ISTERED AND/OR ALTER,REPAIR,SEWER OR
LIC"':ED A5 REQ U;R 'B)' LO (3�L. 5 OUNTY AND 5T E OF SEWAGE WSPOSA SY'ST'FM
i;ALlFORNIA OR TH A7,,,W hM THE LAL W ER OF AND !N D TO --- _
OIICON {ECT PLUG AND
RESIDE .!1, TH \B DESCRI BEP RE !DE TIA PER ABANDON HOUSE SEWER
et
SIGNATURE ,+•! J $A CFlLL SEPTIC TANKS ❑ -
OF PERMIT SEEP, IL tSI ❑ CESSPOOLS CJI
dr ALIDATION" " ROBERT A. WOOD
{ SU:PERVIS;NG MECHANICAL ENGINEER
CK.
CK. M.O. CASH