HomeMy Public PortalAbout9948 WOODRUFF AVE_Sewer__ CA62D°-63 APPLICATION FOR PERMIT r¢
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY" DIVISION BUILDING �'}�� _
JOHN A. LAMBIE, County Engineer ADDRESS � e 4�3- ��:1—_'L -----_.—
WILLIAM A. JENSEN, Sug't of Bullduay {��✓r. 1-��J
NEAREST
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FOR APPLICANT TO FILL IN CROSS ST
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DESCRIP "?N_. LOT NCS OWNER Y`1 ___ --_. 1 • +_.--_
MAIL
BLOCK. ,R:Y C_l ADOR€_SS
NO. �OF L.L`�CiS. �
a,.
SIZE U QT _ NOW ON L.OT TEL. NO. r
US€ OF y
BUILDINGS L..J!'� DiSTt3I C:7 NO. GROUP MRP PROCESSED E3`f
CONTRACTOR
:OTdTRA TOR = -
ADDRL5 CONNECTION DATA
CdfY' f 1 _
L NO. �B�Ih ya�'"J$ 5�ATION DEPT -_
l_.� wC r:•--_._ —..-._ ___
At ,
STATE �i.7PPPK..
Ir Y MANL7LE REFERENCE
'i ^srq-
REG15RAT10N NO. � CQUN CLINT j
NO, "ESC.Ri FTION OF WORK. FEE TYPE OF CONNECTION LENGTH PROM
HOS E SEWER CO NN FC71NG TO j T Y CURB P L M.L. O P.L.
PUBLIC SEWER $.5.p0 -----7-
i SEPT IC TAhK SEEPAGE P(T OR I W
j S ANO,OR DRAINF ELD @ $10.D.O j co.-IMP.NO _. ..�
t nU F SE CR::ONNG'G !NG TO -
PR14AIE DISPOSAL.SYSTEM @ „3.00 TRUNK PERMIT NQ -t' ROAD -ERM IT NO,.
NNECT ADDi7'Oh AL BLDG. OR -- ._ -
Cl- Ai'•FIC)AVIT WAIVER ff0.5 EE�IF.NT RECORD,IN!a7R.NQ. DATE
JJORK T'O r+U J. E SEW LR @ $_.DO
1
OVERFLOW SEEPAGE PIT,DRASNFIGLD
EXTN C£SSPOOL,DRYW ELL..MAYHOLE @ $5.001
HWv, OR ST.WIDENING
. NAB lND6N HOUSE
$3.00 I --___-___—._-
__—. STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
- WASTE APPROVAL
OWNER'i CHARGES PERMIT -- -- - - --- -
AUTHORIZATION Tam—FEE
CONNECTION CHARGE FEE
AUTHORIZATION
'I HAVE Al THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRAC OR
TO €ONNECT THE. ABOVE' DESC Ki BED EXISTING L ELLiNG ----- ry[p �v ------1— ---.I - - --- ----------
TO ;'tE PUSLIC SEWER' APPROYALw I DATE, I�NSPECTOR5 SIGNATURE
SIGNED IRIS -.-DAY O�._.. —_19�_
OVlNEFt(]R NEW HOUSE SEWER
O Yr N.E.125 AGENT_-.._— CONNECT ADDITiONAr
ADDRESS_,__ BUILDING OR WORK 1 i
_.-- —. _— ---- - �— SE PTIC TANK SEEP,PIT(S)
1 {{FREELY ACKNOWI..EDG£ THAT I HAVL% READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE. AR7VE iS CORRECT AND AGREE TO COMPLY
WITHAL.L COUNTY ORDINANCES AND STAT_ LAWS REGULATING �
PLUMBING AND SEWERS, CESSPOOL 0 ORYWELL
t HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR r
LIC11: AS Rc'. 1itH' B'� LOS ANGL€S COUNTY AND STATE OF SEWAGE.DISPOSAL SYSTEM
_�_._
RESIDE fJR nAT i M 'i HE LE' L pVYN ER OF r�.ND INTE.N6 TO _-6—N gL. -P— --- -
RES16E IN, THE DESG,R IBED ES!DENT!. P o.F y ASSN NNE T UG AND
A,BAN DON HOUSE SEWER
SIGNATURE
OF PERMITTEE _ _ BACKFILL SEPTIC TANK,5 El !
SEEP,PIT f5) (� CESSPOOL-, ❑I
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. 1CASH