HomeMy Public PortalAbout9929 WOODRUFF AVE_Sewer__ a°fl 10-63 APPLICATION FOR F
6R642D ERMI
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 13U IL71N
JOHN A. LAMBIE, County Engineer ADORES,K`4�
WILLIAM A. JENSEN, Sup't of Building
LOCALTY VY_
NEA RF_7
FOR. APPLICANT TO FILL IN CROSS S �
OWNER
MAILr
BLt�.CK TRA,".., ' -._/ ', 4 ADORE55
d f
NO OF BLOGS. .�.
SIZE OF LOT `,s^ NOW ON OT C!TY d � T.L. NO.
PG
BUOF R DISTR ICF NO. GROUP MAF' PROCESSED BY
BUILDINGS o , �" -
r _
CONTRACyt '��
ADDRESS �e®NNECTI®N DATR `.._.
T� STAT i Ota �� f` DEPTH F -_
ATEMA
MANHOLE REFERENCE:
Y UPPER
REG!STRATfOM1i NO. d T ❑` COUNTY
NO. GES�:R?PTION O,' WORK FEE 4--_—
TYPE OF CONNECT iON LENGTH FROM --
-A -__ -_ --_ —�--_
,f H `+.SEWER
CONNECTING TO Y „ CURB P,L, M.L.TO P.L
'.Pus iC SEWER CcF $5.00 ...) :.: _---------- --- -------------.--_ ____ ,...
SEPTIC TANK,SEEPAGE PIT OR-..--.-..
PI S AND/OR DRA.INFIELD @ $1.0.00 CO.IMP. NO, _ .eOB Rt0 �Lj
- NNE_""'PvG 7'SINAL BLDG TOR - -_- JJ AFFIDAVIT WAiYEA i RRSe�
TRUNK PERMIT NO ROAD PERMIT NO.
PRIVATE DISPOSAL SYS] :M � $3.00 I
.. � M&4T� RECOF?D.INSIR NO:-- C3ATF_
WORK"TO HOUSE SEWER
i
s
r<N
O R LON SEEPAGE P!1".DRAINFi.'.LD -
XTIt.Cl SSPUOL,DRY Y.E'LL.MA NWGLE�' $5.06
_ _ _-- HWY.OR S7.WIDENING
ALTER.RE OR ABANDON HOUSE �
SF,V ER OR 1?ISPOSA_5YSTCM $�d.b0 STATE ENCROACHMENT
I PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER'S PERMIT _ __$ 2i! 00CHARGES
AUTHORIZATION TOTAL FEE ,�,�yl J �,, CONNECTION CHARGE FEE
'i HAV£ AT THIS DATE_ A CONTRACT WITH THE HEREIN NAMED CON- R.E.!MBURSEMENT FEE
TRACTOR TD CONNECT THE ASOVE DESCft B.'D EXISTING DWELLING --__._ py.__p.)_P/�1-,��pr-_T-T_te�aa-_.____
TO THE PUE3 L'. SEWER, _ APPROVALS
DATE �1 NSPECTOR'S SIGNATURE
OWNERL�. TryIS CONNECT ADSEWENAL
-
:JWNE O? fffy� � t NEW HOUSE SFW ER
OWNERS Arc^tiT.Y---_ ..,e;..re � .�._.__
EP ILDING OR WORK '
AD DR ES> __. _ _ �- __-
-I-HERE BY ACKNO'WLED�H.A. HAVE READ THIS APPLICATION SEPTIC TANK,SEEP PIT(S)
`rP I AND/OR DRAINFIFLD I
AND S?ATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE. LAWS REGULATING
PLU.MS"ING AND SEWERS, CESSPOOL ❑ DRYWELL
I
7 HEREBY CERTIFY THAT AM PROPERLY REGISTERED ANO/OR R ALTER,REPAIR.SEWER.OR
LICENSED AS QU.IRED BY'LOS AT7L&LES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
c L!FORN A THAT I AM THE L Af OWNER`7F, AND INTEND TO DisE NNE_ __UPi C AND -~-
RESIDE IN. H A"s3UYE DESC RI B CSIL N,I/i L. PROPERTY. ABANDON
SEEP;PITL.HOUSE
TA SSPOG�LS JI
BAC KFI LI 5E I
VALIDATION- ROBERT A. WOOD
s SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
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