HomeMy Public PortalAbout9465 WOODRUFF AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION*OF BUILDING AND SAFETY PERMIT APPLICATION
COUNT'' OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGNEAREST
ADDRESS 9;. r ,.:• _ CROSS ST.
LOCALITY DISTRICT NO. SERIAL N0. k PERMIT NO.
NEAREST A I S
CROSS ST ',
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS + USE ZONE OCCUPANCY MAP
BK P6
CITY faY 1' TELAO.4
CONTRACTOR
CO.IMP.NO.
ADDRESS
JOB.N0.
CITY TEL.NO. TRUNK PERMIT NO.
❑ STATE
REGISTRATION NO. Q COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT N0. -
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS �,��r.. , CONNECTION-CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE BY
1
HOUSE SEWER CONNECTING TO f
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. I
ALTER OR REPAIR EXISTING DATE BY
SEWER ORDISPOSAL_SYSTEM 1.00
DISCONNECT AND ABANDON SEWER +
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MAN"CLE REFERENCE
UPPEII L:..Y�S
TYPE OF CONNECTION LENGTH FROM -
Y. CURB M.L.TO P.L.
OWNERS PERMIT $ I 1 00 -
AUTHORIZATION TOTAL FEE I
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH;E PUBLIC SEWER
SIGNED THIS....... -----------DAY OF_.............. __............ 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..:'....-.___.--------. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS......-----......._-------------------- ------ _..--..:-. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFOf#NIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE 13 SCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(]
SIGNATURE
SEEP.PIT(S)o CESSPOOLS 0-
OF PERMiTTEE------------- - -
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