HomeMy Public PortalAbout9522 WOODRUFF AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING �} °" P"' r NEAREST
ADDRESS x`J`) i it-' r k 3 1 7 To- " CROSS ST.
DISTRICT No. SERIAL NO. PERMIT NO.
LOCALITY I r A S
NEAREST ?__
CROSS ST( � f/f � �1 q !� RECEIVED BY Ready for Inspection DATE ISSUED
OWNE 3y � l• d Y L.fj� CL- ` c V
MAIL > } BK PG USE ZONE OCCUPANCY MAP
ADDRESS l -
CITY 'S r 3 TEL.NO.
CONTRACTOR CO.IMP.NO.
ADDRESS JOB.NO.
CITY - TEL.NO. _e TRUNK PERMIT NO.
STATE
REWSTRATION NO. l / '�] COUNTY ROAD PERMIT NO.
LEGAL :, STATE ENCROACHMENT
DESCRIPTIdN 40T N0. PERMIT N0.
4._�.
' 9
BLOCK INDUSTRIAL
�RAGT j y,.:' WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT
USE OF CONNECTION CHARGE FEE
BUILDINGS
NO. DESCRIPTION OF,VrdRK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTI."TO
PUBLIC SEWER @ 11 3.50 h RECEIPT NO. DATE BY
— HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
— CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO. ( DATE I BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 ,
DISCONNECT AND ABANDON SEWER CONNECTION DATA
AND/OREPDISPOSAL SYSTEM
f.00
STIC TANK.SEEPAGE PIT OR DEPTH
_ PITS AND/OR DRAINFIELD 2.00 STATION
CFSSPQOL—DRYWELL I MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY 2.00 I UPPER £yrieir
TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ i 1 00
AUTHORIZATION ( TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS---'.........---DAY OF.....-.-. ........... 14 NEW HOUSE SEWER
.-
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT.... _...... .....; ........ _:......_.
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..-- ------ - ^' ................ ------- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ 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 _
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
ASCD STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 0
SEEP.PIT(S)❑ CESSPOOLS E]
SIGNATURE
OFPERMITTEE.. - - --'------.... --.:.------:..------ .....--..... -
r .
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