HomeMy Public PortalAbout9905 WOODRUFF AVE_Sewer__ 78A
E-663 tt-35 APPLICATION FOR PERMIT 1.
>&E-6$
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS
RD CASSATT D. GRIFFIN, SUPT of BUILDING - ACALITY -
NEAREST
FOR APPLICANT TO FILL IN _ CROSS ST.
LEGAL a ��. 5' Xd°. OWNER
DESCRIPTION LOT_N _
MAIL y r
BLOCK TRACT _ 't _ADDRESS T""'T'-'� •
NO.OF BLDGS. A r
SITE OF LOT( -g NOW ON LOT ?" CITY ,1: _ +--•- -, TEL. NO. -
USC6F 9
BUILDINGS _ +�-'r+� -•�- -*r... DISTRICT N0. GROUP MAP
BK PG
CONTRACTOR. � a'�' s' '"�:. �._ I , ,.r z
ADDRESS �.'"� -r[ CONNECTION DATA
_ STATION °_ ,r- JDEPTH __
CITY _ a p/�,, TEL. NO, sus: ,rp
-- -• '�''" - �''�"� �` MANHOLE REFERENCE " ��
G LOWER
Cs'°§TATE .106. -�
REGISTRATION N0. _+� _ -. • 14Z ❑ COUNTY
No. DESCRIPTION OF WORK FEE ---- --- --
- - -- -- --- TYPE OF ;CTION LENGTH FROM -t
/HOUSE SEWER CONNECTING TO I— Y. CURB P,L. M,L.TO P,L.
iYE '
_ VPUBLIC SER -
$3.50 - - --- - -- - ---
} SEPTIC TANK SEEPAGE PIT OR -
__---I_PITS AN_D OR DRAINFIELD _ (a $.3.00 I - —� �'•
OVERFLOW SEEPAGE Pit,DRAINFIELD P. C. NO. e
EXTN„CESS POOL,DRYWELL.N AN HOLE (a $2.001 CO, IMP.NO-,�q JOB N0.
.-.— ---- - ---- --_-�-
PRIVA SEWER SAL SYSTEM.
70 �, •-;;t ,.x.,
PRIVATE DISPOSAL SYStEM Gi. $1.00 ; TRUNK PERMIT N0. ROAD PERMIT N0.
I CONNECT ADDITIONAL BLDG OR _ STATE ENCROACHMENT
I WORK TO HOUSE SEWER (c, $.1.00 . -' PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE _--- ----- - ------- - --- ----
Iy S'WER OR DISPOSAL SYSTEM INDUSTRIAL
WASTE APPROVAL
----'j --------�- - _ CHARGES -
�--._ CONNECTION CHARGE FEE
OWNER'S PERMIT ------ — ---- ---
-- - �— j I�- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE �4-0
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS ffI DATE �INSPECTOR•SSIGNATURE
TRACTOR TO CONNECT THE AEOVE DESCRIBED EXISTING DWELLING �
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS-- —DAY. Or --�9-
- --- CONNECT ADDITIONAL j
OWNER OR i BUILDING OR WORK -
OWNERS -_
AGENT-_--t _ — --
• - SEPTIC TANK,SEEP,PIT( )
ADDRESS AND/OR DRAINFIELD
�— - _ - ---- ----- -- -- ---
i HEREBY ACKNOYVLE1 F THAT I HA'K'E READ THIS APPLICATION CESSPOOL(Ji URYWELL❑ I
ANO
STATE THAT THE ABOVEIS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINAN!,E_S AND STATE LVNS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 QUI �d3
HCETHAT I AM PROPERLY REGP51`ERF..D AOR DISCONNECT PLUG AND
LICEN
-
S
E
D ;`S REQUIRED L'IRED BY LOS ALLES COUNTY AND STATETE OF _ABANDON HOUSE SEWER
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE -- - - --- - � -- -- ---
DESCRIBED RE'S TIPROPERTY,,,r J / BACKFILL SEPTIC TANKS I] �)
SIGNATURElA�'E- SEEP. L)PiT�S1 CES5P0 LSE]
OP PERMiT7E •jEY' 00 �s - -�--
rY
I
JOHN A. LAMBIE, 77TY ENGINEER 'VALIDATION ROBERT A.WOOD, CHIEF PLE1G. INSPECTOR
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CK. M.o, asR �g