HomeMy Public PortalAbout9823 WOODRUFF AVE_Sewer__ �E808 1
6A642D0-63 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL"�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 9 JI 1_0 ING
ADDRESS
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ADDRESS
JOHN A. LAMBIE County Engineer
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WILLIAM A. !ENSE�, Supt of Building
LO�AL;TY
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FOR APPLICANT TO FILL IN CROSS 5T.
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OWNER
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_SIZE_(.):, i OT NOV•f ON LOT TEL. NO.
USE OF DISTRICT NO, GROi1P MAP il3'r`O�-,ESSD
-BUILDINGS B K po
CONTRA CTOR�
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STATION DEPTH
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STATE MANHOLE REFERENCE UP p
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REGISTRATION NO, OUNT
No. DESCRIPT IGN OF WORK, FEE TYPE OF li0"IE6TION NGT FROM,,�
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HOUSES WER cor�NEcT.Nic--r� T y CURB-— P.L. M.L.TO P.L.
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PUBC SFWF.R @ $5.00 < C.NO
'S E P i�—',C TA-1�K-9 E I f VA_G PIT-OR -_--_ JOB NO
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PITS AND/OR DRArNFIFLD @ S10.00 CO,imp '40.
HORSE SEWER CONN EC-�fNG TO TRUNK PERMIT NO. ROAD PFRM11 v NO C4
PRIVATE DISPOSAL SYSTEM @ $3.00
----------
I CONNEC OR-- ---- DATE
WORK TO HOUSE SEWER @ $3.0
OVERFLOW SEEPAGE PIT,DRAfNFIELD
EXTN..CE-,SF'OOL,E)PYWELL,!IIlt��C��_�_@ $500 HWY.OR ST.WIDENING
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM $3. z
STATE ENCROACHMENT
PERMIT N.O.
q D 5_STRIAE
WASTE APPROVAL
CHARGES
Is Pm
119W 1`I MIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N.&FC) CON- F E—I'MS LSR 53 c—_T FEE
TRACTOR TO CONNECT THE ABOVE. DESCRIBED EXISTING DWELLING DATE INSPECTORS SIGNATURE
TO THE PUUL Ic SrWER. APPROVALS-
SIGNED THJS_,�__-L)Ay,qF___
OWNER OR
NEW HOUSE SEWER
OWNERS AGENT__�_
CONNECT ADDITIONAL
SWILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,PiT(S)
I ti ERt'EY ACKNOW1 FDOr. THAT I HAVE READ THIS APPLICATION AND/OR DRAINF)CLD
AND STATE THAT THE A801�_. IE:, CORRECT AND AGREE TO COMPLY
WITH. ALL COUNTY ORCINANCES AND 51AIC AWS REGULATING
OWNERS
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PLUMBING AND SLW RS. CESSPOOL E'j DRYWELL 0 1
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HEREBY CERTIrY THAT I AM PROPERLY RFGISTERFD .AND/OR E AIR.,SEWER 00.
I IENSED AS REQUIRED By LOS ANGLES COUNTY AND STATE OF SEWAGE D15POSAL SYSTEM
A I .PH DISC—ONN-EC-T PLUG AND
C ALIFORNIA OR THAT I AM !HE LEGAL OWNER OF, AND INTEND TO
P E T.
P RLS!DENTfAL.-PROPERTY,
EStVE IN THE ABOk )DFSCRiBEO ABANDON HOUSE SEWER
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SIGNATURE
BAI�_KFILL SEPTIC TANKS J
C ER M I TT
OF PFRM ITTEE -4-
X SE EP.PIT(5) 1:1 CrSSPOOLS
VALIDATION ROBE RT A. WOOD
SUPERVISING IVIECHANiCA' ENGINEER
CK, M.O. CASH