HomeMy Public PortalAbout9922 WOODRUFF AVE_Sewer__ E-6D
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APPLICATION FOR. PERMIT" 1.
S •6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NE ss szo
— -_r
LEGAL OWNER— -- - — - ----- -- ---
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT F� 'dq y' ADDRESS
N0.OF BLDG5. ---- '— __ -
SITE OF LOT pp NOW ON LOT ,./ CITY TEL. NO.
USE DINGS —` --- DISTRICT NO. I GROUP I MAP
BUILDINGS - - -
-- y BK PG
CONTRACTOR
-' —
ADDRESS CONNECTION DATA
f. .-, - -
_STATION + DEPTH ��
CITY a TEL NO_ t MANHOLE REFERENCE _UPPER
Y' STATE
REGISTRATION NO, x` - ❑ COUNTY
NO. DESCRIPTION OF WORK FEE — -- - _-- --_-
-- ---- ----- ------- - N
-- -- TYPE OF +�FCTIO LENGTH FROM
HOUSE SEWER CONNECTING TO ( t:.
r _Y, RB P.L. M.L.70
PUBLdC 5ELVER. --_-_—._[r`a", $9..59
SEPTIC TANK;SEEPAGE PIT OR -
__ PITS AND/OR D_R_A_INFIELD _ off%_$3,001
OVERFLOW SEEPAGE PIT,DRAINFIELO �" P. C. NO. -
EXTN.._CESSPOOL,DRYWE_L_L,MAN H_0L_E Cc� $2.00.1 _ CO, IMP. NO./ - 6; JOB NO. _
{ HOUSE SEWER CONNECTING TO
_____PRIVATE DISPOSAL SYSTEM_ (<) $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CUNNEC7ADOITIONA.LBLDG.OR STATE ENCROACHMENT
_—�_VORK TO HOUSE SEVz£R $1.00 PERMIT NO,
ALTER.,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (u $1.G
— _.— -.- WASTE ASTE APPROVAL
-------�-- I I---- CHARGES
_ CONNECTION CHARGE FEE.
OWNER`SPERMIT � �� _ 1 DO ----------- - — -
AUTHORIZATION j__T_0TA__L_FE_E_____ REIMBURSEMENT FEE
i HAVE AT.THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS I DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SL„`tR.
NEW HOUSE SEWER III
SIGNED THIS —DAY OF
�� 19_"'}'• CONNECT ADDITIONAL r T
OWNER OR - r� BUILDING OR WO.RK----.-.---^,-----( — — --- -----
dL r
OWNERS AGENT ei'�6pC.(✓ SEPTIC TANK,SEEP.PIT(S) I
ADDRESS -''` ANA/UR DR.AINFIELD
rIEREBY ACK' S,A
-LEDGE THAT I HAVE READ PHIPPP-- ,L
LICATIO
ANDSTATE TY CESSPOOL0T HE ABOVE. IS CORRECT AND A RFE TO COMPLY DRYLVELL['i
WITH ALL COUNTY ORDINANCES AND STATE LA`A'S REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS; _SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DiSCONP4EC?PLUG AND
-
LDESCRIBED
CENSED AS RE41UtRED PY LOS ANG5LES COUNTY AND STATE OF ABANDON HOUSEGAND
SEWER
ALIFORNIA GR TI4AT 1 AM THE LEGAL OWNED• OF THE ABOVE --- — ---------------- - ------ - _
R£oI DE•i�TIALPROPERTY.;' BACKFILL SEPTIC TANKS..❑ i .
f
GNATURE. SEEP PIT(S) >� CESSPOOLS
DF PERbiIT'7EE.-.__.`�
I
JOHN A. LAMBIE, CdUNTY ENGINEER VALIDATION_ ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
E K. N. 0, CASI�y