HomeMy Public PortalAbout9430 WOODRUFF AVE_Sewer__ o
$a 6-683 19•$5 APPLICATION FOR PERMIT 1
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,DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER A➢➢RES
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� CASSAT7 D. GRIFFIN, vuP'T OF BUILDtP1G LOCALITY
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FOR APPLICANT TO FILL IN _ doss s. '
LEGAL OWNER,
DESCRIPTION LOT NO. - _
'-- `MAIL -
BLOCK TRACT ADDRESS
NO.OF BLDGS. CITY ��. TEL. NO.
.SIZE OF LOT NOW ON LOT
USE OF
BUILDINGDISTRICT NO. I GROUP MAP
S it / - _ SK.
CONTRACTOR
ADDRESS CONNECTION DATA. -'-i'> � y -- �..— --- ----- �--
r .. STATION .ijs F DEPTH ,.
CITY i TEL, NO. U
MANHOLE REFERENCE PPER-
LOWER
-REGISTRATION NO. 4'.' ,�-..: ./ ^yb-... - `� COUNTY
NO. DESCRIPTION OF WORK. FEE --- ----
--- - -- TYPE OF rCTiON LENGTH FROM
HOUSE SEWER CONNECTING TO Y- RB P.L. M.L.TO P.L.
PUBLIC SEWER _ -� - --- - _—._
_ ^3.50 ';
SEPTIC.TANK,SEEPAGE.PIT OR - -
PITS AND/OR DR_AINFIEL_DLit s 3.00
j—OVERFLOW SEE PAfE 21 T,DRAIN F IELD —)_—f - P. C. NO.
E.XTN.,C SSPOOL,DP WELL,MANHOLF (n. p 2,00 _�. CO. IMP_. NO. J ! ,: —J68'NO.
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HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ��_°'PAG TRUNK PERMIT NO, ROAD PERMIT No.- $-
JJ CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
JJ WORK TO HOUSE SEWER Ca;
_-' _--- ___.-- _ $9.00 ✓' <:_^E> PERMIT N0.
1 ALTER,REPAIR OR ABANDON HOUSE -- ---.—_ -.._---
SEWER OR DISPOSAL SYSTEM (i I-DO ! I INDUSTRIAL
—,- ----.--�-- ----. ---_-.--_---_ WASTE APPROVAL
CHARGES
---.-. - �.—.-- -- CONNECTION CHARGE FEE -
OWNER'S PERMIT t 00
--- --- --—----------
--------— --- - --- REIMBURSEMENT FEE
AUTFIORIZATION TOTAL FEE r'/— —
I HAVE; AT THIS. DATE A CONTRACT WITH THE HEREIN NAMEDCON- APPROVALS L DATE JINSPECTCR SSIGNATURE
TRACTOR TO CONNECT' THE ABOVE DESCRIBED E.XiSTING DWE.'LLINC, i
TO THE PUBLIC SEWER, NEW.HOUSE SEWER
SIGNED THIS DAY OF.-, CONNECT ADDITIONAL
OWNER OR - BUILDING OR'd.OR)<
OWNERS AGENT g0/ •} r ,,ra it'- _._ - -__. _---._-----�---------------- -
J - _ SEPTIC TANK,SEEP,PIT(S)
ADDRESS '�' s r'r-;�.:" .� Z,, - ,�- _- AND/OP DRAINFIELD
I HIR PY ACKNOWLEDGE THAI 1, VE READ THIS APPLICATION CESSPOOLD DRYVVELLt]
AND STATE I.HAZ THE ABOVE IS CO. ..ECT AND AGREE. TO COMPLY
`'ViTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBI NU AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HERE9Y C=RTiFY THAT I AM PROPERLY REGISTERED AND/OR —._.
DISCONNECT PLUG AND i
LICENSED A.5 ?EOUIRED BY LOS ANGELES COUNTY ANDSTATE OF !
ABANDON HOUSE SEWER
CALIFORNIA On THAT i AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑ '
SIGNATURE /' i SEEP, PIT(S`_L_; CESSPOOLS
OF PERMITTEE -.. - - ---- - -r- -
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR