HomeMy Public PortalAbout9566 WOODRUFF AVE_Sewer__ NO
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& o$ 8-59. APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY 'DIVISION BUILDING
ADDRESS .r}�
10 IN A. LAIMBI£, County Bngxn®er -- ---_
CASSATT i1, GRIFFIN, Supt of Building LOCALITY _
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
_ DESCRIPTION LOT NO. OWNER
BLOCK TRACT _....�.�....�.. _. MAIL
ADDRESS
NO.OF BLDGS.
SIZE OP I OT ---N NOW ON LOT _ CITY Ts L, N0,
USE OF-- _
BUILDINGS DISTRICT NO. GROUPBK PG MAP PROCESSED BY
yn F
CONTRACTOR
S_.._
ADDRESS - .. - - CONNECTION DATA _...
CITY 'IBL.NO-,rt - STATION _ .,�. DEPTH -�•
STATE MANHOLE REFERENCE v UPPER
4C.� - '' �'� COUNTY - -3tfktA✓ i2
No. 1 DE CRIT'I ON OM5RK FEE
�H0USF L J 0 V1 CxIPG TO
-1 PUBLIC SE VER t^-T $3.00 TYPE OF CrJNNEC'TION LENGTH FROM
SEPIIG l Af?IK,SEEPAGE PIT OR Y. CURB P. �` J[L_TO P.L.
PITS A_NWOR DP.AINF1FLD @ .$3.00
` OVERFLOW SLEPAGE PIT,DRAINFIELD
,..E
EXTN..CESSPOOL, DRYWELL C $2.00
—)
HOUSE SEWER CONNECTING TO .�P C.NO.
PRiVATE_Di - OSAL SYSTEM SI.00 CO.IMP NO _JOB N0.
� CNECT AD DITIONAL BLDG,OR TRUNK PERMIT NO ROAD PERWIIT NO.
``.
WONT TJ r'0 ISE SWER $9.00
AL,M:F,L3w:RL.AA.kFT�FIR ABANDON HOUSE S1'.4TC ENCROACHMENT
-- �Ew ER c3.x.a AL SYSTEM $1.00
PERMIT N0.'
iNDUSTR ALWASTE APPROVAL
OWNER'S PERMIT $ 1 2 �0�0�` CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
TRACTOR TO CONN-ECT THE ABOVE.DESCRIBED EXISTING DWELLING APPROVALS DATE �INSPECTOR'S SIGNATUks=,
TO THE PUBLIC SEWER. - -
SIGNED THIS. DAY 0 19� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT— BUILDING OR WORK
ADDRESS- SEPTIC.TANK,SEEP.PIT(S)
--- -- _AND/OR DRAINFI E?D
fiERE3Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE .THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL_El DRYWELL []
W71i AlCCUN!Y ORDINANCES .AND STATE, LAWS ELGULATING ALTER,REPAIR,SEWER.OR
PLUM !'S( ANI) °FWE'RS' SEWAGE DISPOSAL SYSTEM
I HERB CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
DISCONNECT PLUG AND
LICENSED AS RECti7RED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA C THAT I Aon THE LEGAL OWNER OF THE ABOVE --
DESCRIBED RESIDENT I tL,PRO PFRTY. _ BACKFILL SEPTIC TANKS ❑ J
SIGNATURE _ SEEP.P[T(S) CESSPOOLS ❑ I
OF PEP.MTTTT"E �
J VALIDATION ROBERT A. WOOD
CK. W.0. CASH SLIP}_RIIISIIAG NIZCFIANICA.L ENGINEER
76AS420 AP.PLICA TION FOR PERMIT
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i Rc •S59 8•'•9
DIVISION OF BUMDING AND SAFETY EWER-SEWAGE DISPOSAL
Depwtment of County Enginesr
County of T.O$ Angeles FAES
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WI+•9.J. FOX.COUNTY ENGINEER ICASSATT D.GRIFFIN,SVP'T OB BUILDING TYFOR SPP I ANTO ` I L TT. �= _
LEGAL -
DESCRIPTION LOT NO. OWNER `}
BLOCK TRACT - ` MAIL
ADDRF,S5
NO. OF BLDGS.
_SI7E_Uf LOT NOW ON CITY TEL, NO,
USE OF — "—^' F,•^ %' '
BUILDINGS — ,r.. DISTRICT ISI GROUP MAP
CONTRACT
ADDRESS 1 � � CONNECTION DATA
CITY � I STATION
, . ' DEPTH
4
�.- Y%"'S ATE MANHOLE REFERENCE ,tJ "r. ' :" I-,c UPPER
REGISTRATION No. ^- ->-, -- ❑ COUNTY
NO. II D SCRIPTI h 6F VO�R'4 K 'FEE —.` - -- ---------- .-- - --.--
HUUSE SEWER CONNECTING TO -•-� -may. T
I'vYP'c OF CDNNECTI¢}N LENGTH FROM
`.. PUBLIC SEWER_ -_ Cd3`5.0 _-_ d_ L� Y=---..-- CURB—!_i._.P L —>`t-. T3 P:LT.
HOUSE,SEWER ONN. CTSNG TO
PRIVATE DISPOSAL SYSTEM 1.00
I CONNECT ADDITIONAL BLDG. OR —I� i' - P NG
WORK TO i-OUSE SE rER 1.001 _CO ti'P NO. _! ' JCB NO.
-
E4ffR OR D-5POS L SYSTEM LOG TRUNK" FRMIT NO, ROAD.-PERMIT NO.
CISCON N El AND °<BA.NDCN SEINER STATE FNCIia$LHn ENT
AND/OR D SPOSAL S STEM 7,0 _ STATE
N0.
SEPT iC fAN{< SEEPAGE PIT OR t
PITS AND/01 DRAIN-IELD 2.001I INDUSTRIAL -..��.
— --L�_--
DRYW ELL WASTE APPROVAL„�
C L-SS POOL
�_SPECSAL CONDITIONS ONLY 2.00 I--�_I-.__ -- _ CHARG
------ - — Cot!-CTION CHARGE FEE
OWN'EWS . `� ..
PERMIT S pp - - —--- --- — - -- - --_
_ _
,AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE, THIS DATE CONTRACTED A W ~� 9
V,'1TH THE HEREIN NAMED CON- APPROVALS !
TRACTOR TO CONNECT THE ABOVE DESCRiBED EXISTING DYELLING APPROVALS UATi: 1 iN SPEC fOR'S SIGNATURE
TU THE PUBLIC SEWER ---".'— —..""---- 'S --'E
NEW HOUSE SEWER .— f
SIGNED THIS DAY Or 19--
OWNER- OR �, y F (��j CONNECT ADDITIONAL
OYiNERS AGENvT r ' �/L,� `.
-4-----.---�- - ^—_ - - SEPTIC TANK, SEEP, PIT(5) .---
_ADDRESS_ •�' SEPTIC_ANK, SEEP,
I HEREBY ACKNOWLEDGE THAT I HAVE READ HIS APPLICATION CESSPOOL CS DRYWELL _
AND STATE THAT THE ABOVE IS CORRECT .AND AGREE TO COMPLY
WITH ALL CUUNTY ORDINAN C>' AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/GR DISCONNECT'PLLiG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORivIA 0;3 THAT I ARL TYE LEGAL OWNER Or TFI ABOVE ABANDON HOUSE SEWER
DESCRIBED 6iEuI EN_,7j�, it(SPER7Y BACKFILL SEPTIC TANKS Ci
g
� SEEP PIT(S)) L cEssPooLs fl -
GF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A,WOOD. CHIEF FLRG J ISPECTOR
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