HomeMy Public PortalAbout9460 WOODRUFF AVE_Sewer__ 76A
E-663 Y1-SS APPLICATION FOR PERMIT
5&E•66
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Depcirtment of County Engineer
County. of Los Angeles BUILDING
JOHN A. L.AM61E, CeLiriry ENGINEER -APDRESSi ` --
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CASSATT D. GRIFFIN, SUP'TOP BUILDING LOCALITY ` ,r�t� 7s%r,.: ,L•a'��- _� - 'P'.-P__,—_._
NEAREST
FOR APPLICANT TO FILL IN CRoss sT. -
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LEGAL -�
DESCRIPTION LOT NO, -. 4: ,` ; < RWNER A
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MAIL
BLOCK TRACT �... _. J
ADDRESS ----------
NO. OF BLDGS. J'" -CITY d ', TEL, NO.,
SIZE OF LOT NOVd ON LOT S;'",... ,,
USE OFDISTRICT N0. i GROUP I MAP
BUILDINGS __ ___
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SK P G
CONTRACTOR
CONI+TECTYOPi
ADDRESS ",� �„ o __._ -- --- ---DATA --- --- --
rc _ STATION ''_ may_ DEPTH
CITY t= pw ''{' TEL_NO. � 5- MANHOLE REP ERE
4;j-STATE _.—_ �,�..��_V_—�`✓�— =�'8`4'.u'
REGISTRATION No, y `j u COUNTY
-NO. DESCRIPTION OF WORK FEL ----.. - -- -- - ----4 ---------SEWER CONNECTING TO - TYPE OF-GONFIECTION LENGTH FROM '.
PUBLICSEWER @ $3.50HOUSE � = CURB :F- v. M.L. TCP [.. ..,.
SEPTIC TANK-SEEPAGE PIT OR
_i PITS AND/OR DRAINFIELD
OVERFLOW SEEPAGE PIT, DRAINFIELD ) > ��,* P C N0.
,- EXTN.,CESSPOOL,DRYWELL MANHOLE la $2.[OI1 CO.,1mP NO. ' _ter, _ _--_.JOB NO,
_ ' SYSTEM -_ TRUNK PERMIT NO ROAD PERMIT NO. d
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL tc $ ..00
C0NNEC7 kpDI710hAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE s 1.00 .. _ PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE I i INDUSTRIAL
SEWER OR DISPOSAL SYSTEM T cru $1:00 WASTE APPROVAL
I _
..-I_ — -----` ---- ------. - CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT1 00 ---------------- ----
--'--� --- ---- '
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
`
d HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS i DATE jINSFEC70R'S SiG'cd A7URE
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TRACTOR TO CONNECT THE ABOVEDESCRIBEDEXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER i
SIGNED THIS——DAY OF 19-_ t".ONNEC7 ADDITIONAL
OWNER OR ./ BUILDING OR WORK 1 -
OWNER$ AGENT�---- � t _ ---- -------- ------------i---------'--------
-`'t'"--AllZ!' - 'f"` '�e- - --'-- SEPTIC TANK,.SEEP,PITS)
ADDRESS
ANVOR DRAINFILLD
_ _ _ ---- -----------..._-._._--- -. .---'--------I---�._..-----------
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL[] �
AND STATE THAT THE ABOVE IS CORRECT AND AGREF. TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGALTER,ALTER,REPAIR SEWER OR 1
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY" REGISTERED AND/OR DISCONNECT PLUG AND -
LICENSED AS REQUiREO BY Lt)S ANGELES COUNTY AND STATE OF I
CALIFORNIA OR THAT I A THE LEGAL .(3 NER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL OPERTl s.- �._ �, BACKFILL SEPT!C TANKS 0 — '-_--
.,.* SEEP.PIT(S) O CESSPOOLS ELI
SIGNATURE �. .+'.0 xt —. ---
OF PERMITTEE
fi
IOHN A. LAM BIE,CQ NTY ENGINEER -VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CASH