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HomeMy Public PortalAbout9923 WOODRUFF AVE_Sewer__ 6A64_Iaa-s3 APPLICATION FOR PIEIROT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT' OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING .� JOHN A, LAMBIE, County Engineer ADDRESSd r WILLIAM A. JENSEN, Su,p`t of Building � p - NLARES FOR APPLICANT TO FILL IN CR ° s S GN LOT NO. OWNER frp MA!L d BLCiCK TRACT .? ADDR€SS LT. OF LUGS. _ . SIZE OF LOTN9!O'W ON Lr;T t:l;-y -pr-. TEL.. NO. - — ---- USE O p .. D'7TRI1NO, GRUi1PMAF PRO('LSSF_'C BY r fy � CONNECTION DATA ADbRkSS ✓3 �+L "i der- - ' - DEPTH CITY _ TEE -.-..i STATION ai- - - ig"F C'ISTRATION C1T. MANHOLE RLFERt NCF No. ! GESCRIPTON OF WORK FEF' ="--- ---- ---._- -_-- ----__ _ 'TY PE OF CONNECTION LENGTH FROM F HOUSES WEF2 CORN€6TINi�TO � Y. J CURB F.G.. M.L TOP.L, PUBLIC SEWER $5.00 -'1 --- OL SEPTIC.TANK,SEEPAGE PIT OR -_-- - rt P.C.NO, n Co. IMP. NO. �'.: ,IOB NO. PTS AND/OR DRAINFiELD � $'.0.00 NO SE SEWER CONNECTING T6 ! fd' TRUNK PERMIT NO, ROAD PERMIT NO PR VA 8* -E I PO^�AL SYSTEM Oh N_C'T ADDITIONAL BLDG OR ! AFFIDAVIT ! wa.tvea Bks&MCMT RECORD INSTR N.DDATE WDRK.TO HOUSESEWER UY ER FLpW SEEPA'sE PIT,DRAfNFi ELD � I I Y � 1 EXT N.,C:E SPO...... WEI..L.,MANHO_E $5.00 �. --- ---- HWY. ORST.-WIDE NTNG — � ALTER,R PAIR OR ABANDON HOUSE I P -.___-__ `' � EWER OR DISPOSAL SYSTEM_ @ S3.00 "-- ----"� — -- --"-_---- —' .—_ _ __._ STATE EN CROACF MENT PERMIT NO. INDUSTRIAL ! WASTE APPROVAL,. ®WNER`S PERMIT 2, ea ------------- —cH_ARc;Es-_.---- AUTHORIZATION 'TO'T'AL FEE __-_ --,! — C:---_ rtON CHARGE FEE —�6 FEE 'I HAVE AT THIS DATE. A CONTRACT WITH THE 44fi EIN NAKED CON. ----REIMBURSEMENT - TRACTOR TO ^ONNrCCT THE ABOVE: DESCRIB EXISTING DWELLING --- - -----_- --- ----- TO THE PUBLIC SEWER.�„ APPROLS DATE INSPECTOR SIGNATURE SIGNED THIS OF_ .OWNER OS 1 NEW HOUSE SEWER -! OWNERSAGENT , --'— CONNECT ADDITIONAL I BU LD;NG OR WORK }`- ADDRESS .- _ 1 HFRERY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION SEP flOR QPAI S€i PLPI'T(5) ANOi QP'i Dr'AINFlLLD AN!i STATE THAT 7s{E' AHOVE ;5 CifPRECT AND AC RE6 'TG rp M.P I_Y W 1'f I ALL TCSUNTY ORDINANCES AND STATE LAWS REGULATING PLUMEI AND SERVERS. CESSPOOL [7 ORYWELL [� ! I HEREBY CERTIFY TNA I AM PROPER...*' EG,ISTERED =AND/OR ALTER,REPAIR,SEWER OR - LI'Eh-EJ AS RE4 " ED: BY LOS ANLL -6<U�N��ANIJTE-- 'lr TE 4`` SEWAGE DISPOSAL SYSTEM _I AL.IFQRNIA OR Y T 7 M T-F_ EC=AL K1.r) OTO . -- --- - -"'- -' '--- -- x ONNE RLI, AWD isTHE BOl°g�GE f.R'HFD IDLY. ADAAND`fN 11pI15E SFWFs4T GIG NATURE � F7F PERMITT E -� BACKPILL SEPTIC. TANKS + I ALIDATIO /J ROS a. woc�I� r' SUPERVISING MECHANICAL ENGINEER CK. M,O. ' CASH ara- '