HomeMy Public PortalAbout9817 WOODRUFF AVE_Sewer__ CE808 2/70
765A 642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 7
JOHN A. LAMBiE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING
BUILDING IN7G--
ADDRESS
L OC
OCALITY
r
.T
�..E
R APPLICANT TO FILL IN NEAREST
CROSS ST
;PRINT OR TYPE ONLY)
LEGAL ON
IESCF�WTION_
C SC.-r- OWNER
MAIL
78LOCK TRACT A-DRESS
NO. OFBLDGS,
SIZE OF LOT NOW ON
LOT CITY TEL, NO
USE OF Z"
BUILDINGSDlSTRJCrArRoUPj'C,LA5S MAP Pp.-ocE$SEo BY
SK pr
CONTRACTOR, `3
ADDRESS CONNECT
C!TY 'TEL, STATION DEPTH
STATE: LIC
LICEN NO CLASS MANHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CqVUZr4lON LENGTH FR61
H HOUSE SEWER CONNECTING TO Y. I P.L. M.L.TO P.L.
PUBLIC
BLIC SEWER $5.00
S EPT,c TANK.SEEPAGE PIT OR P.C.No.
PITS AND/OR ORAINFIELD 0 $10,00 co.im JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT AQDIT{ONA BLDG OR AFFIDAVITC
WAIVER EASEMENT RECORD.fNSTR. NO. 1 DATE
WORK TO HOUSE SEWER $3.00
0 OW SEEPAGE P�577DRAINFIELD Df.
CE55POOL.DRYWELL.MANHOLE $5.00
HWY. OR ST.WIDENING
ALTER.REPAIR OR ABANDON HOUSE
`:N�CROACHMENT
_EWER OR DISPOSAL SYSTEM $3�00 _S-FATE
PERMIT NO. _Lf
0-
INDUSTRIAL -"A
WASTE APPROVAL z
CHARGES
OWNER'S PERMIT s i 2 00
AUTHORIZATION I TOTAL FEE 7-1 1--.' CONNECTION CHARGE FEE
I HAVE T AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENfTIE
TRACTOR
R TO
CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE P UBLIC SEWER. APPROVALS DATE, IINSP TOR 5,41G I YATURE
SIGNED THIS, AY OF f3_
OWNER OR _E
1�
N NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK___
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/O R DRAINFiELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLT:
M13 INC. AND SEWERS
RS, CESSPOOL El DRYWF L ❑
HEREBY CERTIFY THAT M PROPERLY REGISTERED A?4D/OR ALTER,REPAIR.SEWER OR
-
LICENSED A S ,KCQUtRE.D ly)S ANGLES couNrY AND STATE OF SEWAGE DISPOSAL SYSTEM
C E
FORN.,t&-`8R THAT I AM T E
,.g�A4CVV NfO OF. A N 0 INTEND T 0 DISCONNECT PLUG AND
RESIDE JA, THE ABOVE DE_stw1RE ESIO TIAL PROPERTY. ABANDON HOUSE SEWER
SIGN
";o' S.�ACKIILUSEPTIC TANKS
OF PER MTT7 F,Fn SEEP.
IT'S' 0 r CESSPOOLS AP11
VALIDATIOJ A C K R. ALL
SUPERVISING MECHANICAL ENGINEER
CK, M.O. 6"CASH
1_ 7