HomeMy Public PortalAbout9935 WOODRUFF AVE_Sewer__ �E808 10-63
6A6420 APPLICATION FOR PE IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION
ADORES
_ 7�
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN. Sup't of Building
LOCAs-:TY
I
FOR APPLICANT TO FTK IN cR5
LOT NO
CRIy�r C, ON N E 11
LEGAL
DES p p,14 -r--a4
AIL
ADDRESS
SS L
BLOCK
TRACT
_ 57-y-
TEL. NO.
SIZE OF LOT NOW ON LONO. OF BLD
T CITY
USE OF
a yjLDDISTRICT NO. GBK PG ROUP MAP BY
-I <--, .
s,
CONTRACTo .
L _ f- -
CONNECT
ADDRESS
s
STATION
DEPTH
TATE
MANHOLE REFERENCE
COUNTY Y
CITY TEL..
R OUNIT
REG ISTRATION, _140� z--
rN 0. DESCRIPTION OF WORK I'VE -TYPE OF CO TION LENGTH F 'M
Y F�� P.L. M L.TO P�
HOUSr -WERCONNECTiNGI LLL
PUBLIC SEWER @ 00
SEEPAGE prr OR CO.IMP.NO. JOB NO:
AND/OR 0RAIN5frLD 0 0
-0 J- ------
HOUSE SEWER CONNECTING TC TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $3.00 1
vFT WA 0
6N-NECT�AODMONAL-01LDG,OR I IVER [ASEMvirr RECORD. INSTR. NO. DATE
I WORK TO HOUSE SEWER @ $,-,,00
t&VERFLOIN SEEPAGE PIT,D`RATNF!E10—
EXTN XESSPOOL.DRYWELL.MANHIOLE 0 sS.00
ALTER,REPAIR OR ABANDON H Wd OR
z
,5FWEF�OR DfSPOSAL5YSTEM. @ $3.0
0 STATE E CHMENT 7
PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
--CHARGES
OWNER'S PERMIT
AUTHORIZATION 'AL FEE CONNECTION CHARGE FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA14ED CON- REIMBURSEMENT FFE
TRACTOR T CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 0 1 APPROVALS -:CTOR'S SIGNATURE
TO THE PU 8L IC SEW DATE INSPE
SIGNED THIS DAY OF
NEW HOUSF EWER 0 W N E R OR
OWNERS AGENT—- CONNEc r ADDITIONAL
BU I LD:NG OR WORK
A D D R E S S
SEPTIC TANK,SEEP.PIT(S)
IFE
HREBY ACKNOWLEDGTHAT I HAVE RfIAD THIS APPLICATION ANWOR DRAINFIELD
AN, STATE -THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWER$, CESSPOOL 0 DRYWELL [I
1 HEREBY CERTIFY THAT I AM PROPERLY REG'$TERDE%TAN /OR AL.TER,REPAIR, EWER
TAN STATE
EM
p
C�:NFED AS �WI.15PIRED BY LOS ANGLES COUN . _ OF SEWAGE DISPOSAL SYSTEM
CALIORNIA��`R. V4AT 1 AM, THE E OWNER AND INTEND 1-0 DISCONNECT
US AND
"OVE DF"C' S
RESIDE I HVA16OVF OFSCR!s �.7CX'NTIA17P...-ER11. ABANDON HOU E SEWER
SiGNAT
BACKFILL SEPTIC TANKS ❑
OF PERMITTEE---_-U T —-----elt- SEEP,.PIT(5) Ej CESSPOOLS C]l
VALIDATION- ROBERT A, WOOD
CK. M.0, I CASH' SUPERVISING MECHANICAL ENGINEER