HomeMy Public PortalAbout9902 WOODRUFF AVE_Sewer__ 5 a F.:F-6D
i APPLICATION Rl.� R PERMIT 7
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles '3UILDIN
JOHN A. LAMBIE, CGuNI-Y ENGINEER 4DDREss —' --
7 CASSATT 0. GRIrF'IN, SUPT of BUILDING LOCALITY C:T
FOR APPLICANT TO FILL IN doss s
LEGAL -- - --- -o .__ 1..--------
DESCRIPTION OWNER_—LOT NO y g - —�-- -
MA1L
BLOCK TRACT +r �� 4DDRESS
-- NO. OF BLDGS. CITY - -
S1ZE OF LOT �'- NOW ON LOT ,� t TEL. NO.
USE OF - - - ---- ---�--- DISTRICT N0. GROUP I MAP
BUI1,131N GS T I - EtK PG
CON'TRAC'TOR
ADDRESS l CONNECTION DATA
STATION bj _ � �
CITY TEL N0. - _ _� -�, DEPTH
MANHOLE REFERENCE UPPER
.
-
❑ STATE ----'------. r_,'-"i------ - - R`
REGISTRATION NO, - - ❑ COUNTY
NO, D€SCRIPTION JF WORK FEE --- --------- __.
-- -- --- -- —.--- --.- TYPE OF CQUIIEECTIO.N LENGTH FROM .r, -
NOU5E SEVER CO"VNECTIIdG TO I �..- , � -�
PUBLIC SEWER n $3 50 _URB P.L. 'K t TO P.L.
-� SEPTIC TANK SEEPAGE PIT OR -
_ PITS AND/OR DRAINFIELD _(a $3.00 = -- -- ---- -------------
OVERFLON SEEPAGE PI DRAINFIELD - —I -�- -- _---' P N0.
E.(TN ,CESSP00L,DRYWELL,MANIiOLE fa. $Z.00�_ I £O. IMP. NO. 1' 308 NO.
HOUSE SEWER CONNECTING TO.
(,-
PRIVATE DISPOSAL SYSTEM a
-,_-_ -._-__- $t.00� RUNK PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG OR ! TATE ENCROACHMENT
_ WORK TO HOUSE SEWER 1i7: $I.OG PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE ---- ---- - ---�— ----
DISPOSAL SYSTEM . INDUSTRIAL
SEWER OR
- -`----------_----�t.00- I _ WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OW'NER'S PERMIT S 1 00 ------ — ---------------------- —
AUTHORIZATION TOTAL FEE — 1!576�z.F REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- __-.APPROVALSI DATE 'INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT' THE ABOVE DESCRIBED EXISTING DWELLING I I
TO THE PUBLIC SEWER, NEW HOUSE SEWER.
i '
SIGNED THIS DAY OF 19 ,ONNECT ADDITIONAL
OWNER OR ft UILDING OR WORK
OWNERS AGENT
--- '--' - FPTtCTANK SEEP AI7tSI
_ADDRESS ANr,/OR DRAINFIE,4.D
1 HEREBY ACKNOWLEDGE THAT I HAVE READ 'THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL L'.i DRYW€LL(]
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR �
PLUMBING AND SEWERS,. _ SEWAGE DISPOSAL SYSTEM I I_
I HEREBY CERTIFY THAT 1 AM P'ROPE'RLY REGISTERED. AND/OR DISCONNECT PLUG AND j I
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OP THAT I AM THE LEGAL OWNER OF 'THE ABOVE --_-- - -- -- --- ---- -- ---
DESCRIBED RES DENTrIAL PROPERTY BACKFILL SEPTI TANKS
SIGNATURE SEEP.PIT(S) i_ CESSPOOLS`
OF PERMITTEE, .---__�-
1OHN A. L_AMBIE. COUNTY ENGINEER VALIDATION _ ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. N.0. 4. 51.1
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