HomeMy Public PortalAbout9608-9612 WOODRUFF AVE_Sewer__ 3.55 7GAE
SE4.'•-6C: APPLICATION ION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEINER-SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING f )
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATi D.GRIFFIN,SUPT OF SUILDIMG LOCALITY
FOR APPLICANT TO FILL IN -NEAR
EST
DESCRLEGL
IPTION_—_LOT NO"cP.'` '* - A OWN£R'_ .__ �
BLOCK TRACT 2.
MAIL
ADDR -:
NO. OF BLDGS.
SIZE 0€ LOT -/ 6 NOW ON LOT r� CITY � TEL. NO. +''�
USE OF
DISTRICT 110, GROUP MAP
CONTRACTOR +[" vs.•g - --- !---__.. —4_ 3.-"', -.�'��.
ADDRESS CONNECTION DATA
CITY Y TEL. NO. Vii° G+ STATION L- ` r~' DEPTH ✓4,
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�^ nSTATE MANHOLE REFERENCE ��y�% (�r;., tl UPIE
REGISTRATION NO, -_ CCUNTYNO. DFSICRIPTION 0:WORK FEE
TYPE OF COLENGTH FROM
HOUSE SEWER CONNECTING TO Y,_`- -----Y . L-. TO
—' PUBLEC SEWER $ 3.50
_Z HOUSE SEWER,CONNECTING CTING TO
PRIVATE DISPOSAL SYSTEM
,�} I
CONNECT ADDI TIO 1. L BLDG.OR - 't`-- F P. C. NO.
WORK TO HOUSE StaJER ,�-1.00 ' CO_IM�. NO._-- --JC_8 YO
A 'SEOR REPAIR.EX STING TRUNK PERMIT NO, ROAD PERMIT NO. iI
r4ER OR Dkw,D-L SYSTEM N 1.00 -
-ISCONNECT APlD ApANDON SEWER -_' STATE ENCROACHMENT -�
IIiSP05.4L SYSTEM 1.00 PERMIT NO._
SEPTIC TANK. SEEPAGE PIT OR l
' I PITS ANNOP DRAINFIELD 00 INDUSTRIAL -
CESSPOOL DRYWFLL - --- - WASTE APPROVAL
SPE CIAL CONDITIONS ONLY 2.00 CHARGES
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CONNECTION CHARGE FEE
OWNER'S PERMIT S I 11
00 --- —-- --- -- -— -------- — I
-- --- —� —---
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE y�
I HAVE THIS DATE CONTRACTED 'WITH THE HER J `VANED CON-
Tr.ACTOR TO CONNECT TAE AUOlE DESCRIBED EXN-:NG DWELLING APPROVALS 7 1,Tc, URE
To
TO THE PUBLIC SEWER W-1 -
, ' NEW HOUSE SEWER 99j
SIGNED TH] �r DAY OF 19 V—
—T------
OWNER OR CONNECT:ADDITIONAL ..
OWNERS AGENT 9UILDING OR WORK _ I.
SEPTIC TANK,SEEP, PIT(S)
�I
ADDRESS- --- ANDiOR DRAINFIELD
J HEPERY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL C DRYWELL C
APD STATE THAT THE ASOVE SS CORRECT AND AGREE TO COMPLY
WI"TH ALL COUNTY ORDINAP:CES AND STATE LAWS REGULATING r- -�
PLUG?-AL AND SEWOR A -.ALTER,REPAIR,SEINER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED Aro/CR _--- - -`
LICENSED AS REQUIRED BY LOS- ANGELES COUNTY AND STATE.OF DISCONNECT PLUG AND
CALIFORNIA OR THAT J AM THE LEGAL OWNER OF THE ABOVE .BANDHOU.aESE4VER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS�°
SEEP.
FI_
(S) Ci CESSPOOLS[]
SIGNATURE
OF PERMITTEE t "A'" �'I,��;,eKl
WILLIAM J.FOX,COUNTY F-NGiNEEF2 VALIDATION R.A.WOOD. CHIEF PLED. INSPECTOR