HomeMy Public PortalAbout9415 WOODRUFF AVE_Sewer__ ji
6A5420 70 APPLICATION FOR PERMIT"
COUNTY OF LOS .ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
ADCRESS
IQHN A. LAMBIE. County Engineer -
WILLIAM A. JENSEN, Supt of Building Y
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NE. RF'T
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FOR APPLICANT TO FILL IN Ross ST.
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BLOC=K TRACT +s° f`. �' ADDRESS
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512E OF LOT �fLW I!, LOT CITY TEL. NO. k
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ADDRESS f ° r CONNECTION DATA
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CITY �.�,�s,.;� `�F`14: _.,._TEL NO.
MANHOLE REFERENCE
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NO SCr . C.
--TY - - - -` LENGTH � - --
_ A DE_RIPTION OWORK FEE - TYPE OP(__�-C�3� � ROM
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,{T'NOUS SY WEA COh NEC,ING 70 Y. f CURB,, P.L 11.L.TOP L.
F L PLIC SEWER. L. $5.00
-SSE PTI YAN✓ S EP AGE PtT_�,R -_ _j ____.I -__ -_. �� p v., NO- 0
CO.IMP NO / JDB NO. 9,d
PITS AND/OR DRAIN IEL D. C $10.00 ----. tj
SEVJ
-,-F;ONNECTING T7 - TRUNK PERMIT NO. ROAD PERMIT NO. ^F `
PRIVATE DC P05AL SYSTEM _.._-
-__-.-_ _,__
ONNEJ:T ADDITIONAL BLDG.OR AFF{DAV.T I WAIVER EASEYENS RECORD. INSTR.N O. DATE
WORK.TO HOUSE SEWER Q $3.00 I (L)
i
j OVERFLOW SEEPAGE PIT,DRAINFi.ELD
' X N.,CE SI'OOL,OR WELL„MANHOLE C $5:00
_-.-1 _.___ __-__ __.__-- -_____. HWY,OR ST.WIDENING `
ALTCR,REPAIR OR AgANDC7N HOUSE
WER OR DISPOS
AL SYSTEM 0 $3.00 ___�- __-__--.______.--_._.._.—___-.____-__-__--______._._-:__.__
..-_-_ T__.__-__ 5?ATE FN CROACHi�I E.NT "'
PERMIT NO.
iNOUSTRIAL
j 1 WASTE APPROVAL
.__._.__________- _____- __�_.._. __.._-_. CHARGES
OWNER`S PERMIT 21 00 --- - ---- -- ---- -- -- --- ---
�, '! -_-� CONNECTION CHARGE PEE
AUTHORIZATION, TOTAL FEE 1 y i�e --,-----_ - -------------- ----------------
'i HAVE AT THIS DATE A CONTRACTWITH THE HEREIN NAMED CON- RE_MBURSEMENT PFE
TRACTOR TO CONNECT THE ASO VE:
DESCRIB£O EXISTING DWELLING ----- -------------------- -
TO THE PUBLtt_ SF.W'LR. APPROVALS ! DATE I INSPECTORSIGNATURE
SIGNED THUS -----DAY O�.,----•-- l9_._.. ------ -----_.-----------------1--- °---�-- --- ------- -
OWNER OR „ -'� NEW HOUSE SEWER
OWNERS AGENT.
CONNECT ADDITIONAL.
BUILDING OR WORK
SEPTIC TANK,SF._F. PIT fS)
I G
HEREBY ASKNOWLED E 'YHAr HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
W IT Fi ALL .^_OU NYY ORD!NA NOES .AND STATE LAWS REGIJ LAYICdG
CESSPOOL. ORYWELL ❑
PLUMPING AND SE ERS. ..
IHEREBY CF.RT:P': THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR j
Li C FNSED AS REQUi RED BY LOS ANGLES OU NT'Y AND STATE_ OF SEWAGE DISPOSAL SYSTEM i
GA LI
ORN IA OR THAT 1 AM THE LEGAL. OWNER OF, AND INTEND TO. DISCON NFCT PLUG AND
� ^_RESIDE IN, THE ASOYE _ESC.Ri BED RESIDENTIAL PROPERTY. ABANDON HOI35E SEWER
-
SIGNATURE BAc KFILL SEPTIC TANKS ❑
:JF PERMIT7F E,A SEEP.PF.($-) El CESSPOOLS 1 -
--
VALIDATION ROBERT rA, WOOD
�*`'� CK. M,0 CASH SUPERVISING MECHANICAL ENGINEER