HomeMy Public PortalAbout9427-9435 WOODRUFF AVE_Sewer__ 24650 1
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CES 0 8
76'A642D 6.60 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
WILLIAM
A. LAMBIE, County E ADDRESS
LLI M A. JENS
A EN, Supt ingB121dir-, LOCALITY
NEAREST
F9R APPLI98M T94nU CROSS ST.
LEGAL
DESCRIPTION L LOT NO, OWNER
BLOCK TRAC d MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO,
USE OF
BUILDINGS
DISTRICT GROUP MAP ROCESSED BY
BK PG
CONTRACTOR
VE
TOW DATA
ADDRESS
CITY
EL.NO. y r STATION DEPTH
STATE MANHOLE REFERENCE
UT
REGISTRATION NO. , - Z COUNTY
B
_S — ,
, LOWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 33.00 TYPE OF g#?KrMjON LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. �'tURB P.L. M.L.TO P.L.
ITS-AND/OR DRAINFIELD_.._. (o) $3.00
OVERFLOW SEEPAGE PIT, DRAJNFIELD
EXTN..CESSPOOL, DRYWELL $2.00
HOUSE SEWER CONNECTING TOP.C.1,40.
PRIVATE DISPOSAL SYSTEM @ $1.00 _CO.IMP, NOv "T JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO� ROAD PERMIT NO. 0
WORK TO HOUSE SEWER $,.,oo U
A
-'RR`P A 1�P OR I A B4 N D 1)11 HOUSE STATE ENCROACHMENT 14
S I�00 AL 'STEM $1'00 —PERMIT NO. 0
INDUSTRIAL 18
WASTE APPROVAL w
CHARGES U)
OWNER'S PERMIT 119 21 00 CONNECTION CHARGE FEE
AMORIZATIONI TOTAL FEE C REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
.0 THE PUBLIC smql. ti
SfGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR CON NFCT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,
AND/OR DRAIN
1 81 z ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [3 DRYWELL
WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING —
ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS,
SEWAGEDISPOSAL,SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR 'THAT A -AM THE LEGAL,RNEW'-laF THE ABOVE ABANDON HO.USE SEWER
DESCRIBED RESIDrNT44L PROPERTY, BACKFILL SEPTIC T=DELS
SEEP. PIT(S) ❑
C
SIGNATURE
0.F PERMITTEE
VALMATIO�L ROBERT A. WOOD
CIL M.0. H SUPERVISING MECHANICAL ENGINEER
Lei, 3 '1 0 7 DEC 5 5k), F
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