HomeMy Public PortalAbout9959 WOODRUFF AVE_Sewer__ 76A0420
E-663 If-55 1t•5s APPLICATION 1=`OR P.E� MIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LADDIE. COUNTY ENGINEER -_ADDRESS
') CASSATT D. GRIFFIN, SUPT OP BUILDINGb�-
!OCALITYa,,.ti.,..
---—
NEAREST "
FOR APPLICANT TO FILL IN CRcs5 ST. , .' s. , -
LEGAL _£^� OWNER
_DESCRIPTION _LOT NO. _ _ _ __ __ _ �r-s.--%y'•- -f.-
AAIL
-BLOCK -TRACT �, .` qts--- ----� DRESS _--41�'_1101q ..� .
�r N0.OF BLDGS
SIZE OF LOT Ifa `Y6_rt9 JNOW ON LUT � CITY N0,
-- -•3�-.—r-_.-----
USE OFBUILDINGS DISTRICT NO, i GROUP I MAP
i BK PG
CONTRACTU- '--" `G.' "1' I -.•-'`` ! '._."� firESS ..
CONNECTION DATA
ADDR
STATION a. �y DEPTH dr;
CITY TEL.NOae-y�� --
--- MANHOLE REFERENCE
�' '✓ // ;>�; STATE
REGISTRATION N0.NO, DESCRIFTCON OF WORK FEE ---- -- - --
HOUSE SEWER CONNECTING TOTYPE OF F TION LENGTH FROM „ i-
�.- PUBLIC SEWER _--_ C $3.50 _,N ` -Y.- P.L. M.L. TO P.L.
_ �'µ
SEPTIC TANK SEEPAGE PIT OR
_PITS AND/OR GRAINFIELD @ $3.00 i ------
OVERFL W SEEPAGE PIT DRAINFIELD �I —`I f �. P G NO.. -
EXTN.,CESSPOOL.,DRYWELL,IIANHOL£ a $2.00! CO, IMP, NO. f ,.. z ,-- JOBB NO.i_.
HOUSE SEWER CONNECTING TO
1.00 _ - TRUNK PERMIT NO. ROAD PERMIT N0.
PRIVATE DISPOSAL SYSTEM (cL�. _
CONNECT ADDITIONAL BLDG OR �J STATE ENCROACHMENT
WORK TO HOUSE SEWER (% $1.00 � L _-- PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE -_-- INDUSTRIAL -_- --- -_ --------~-
-_�_SE,A'ER OR DISPOSAL SYSTEM (cT_$1,00 _ VIASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00 — -- —— -------- ---
-- REIMBURSEMENT FEE d -
AUTHORIZATION TOTAL FEEfi
APPROVALS r; INSCTGR SSTC, i
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- -.-
RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
10 TrtE -PUBLIC SEWER. � - •.EVl HOUSE SEWER
-- ,
SIGNED THIS- nA'r _ _19_—_ CONNECT ADDITIONAL r -- - --
OWNER OR --.,,, BUILDING OR WORK I I
OWNERS AGENT —F - — _--
SEPTIC TANK,SEEP PIT(S) -- - -----
ADDRESS y���!"***. y _!_ _ AND/OR DRAINFIELD_---
I HEREBY ACKNOW{EDGE THAT I HAVE READ THIS APPLICATION CESSPOOL D DRYWELLL_� _
AND STATE THAT THE ABOVE" 15 CORRECT AND .AGREE TO COMPLY ------- - -- -- ! -- - ---- .- —.__ _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR �^
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANCELES COUNTY AND STATE OF ABANDON HOUSE SEWER I
CALIFORNIA OR THAT I AM THE LEGAL'- Of SHE ABOVE -- ----- --------
DESCRIBED RE IDEN_T .L PRO / BACKFILL SEPTIC TANKS
I�
a'r �, °� SEEP.PITD
S) LI CESSPOOLS
SIGNATURE - -.., ,. N +-- e --- - -- - I
OF PERMIT I Is ---------
IOHiN A. LAMBIE.COUNTY ENGINAR 1—YALIDATION ROBERT A.WOOL), CHIEF PLEIG. INSPECTOR
Ad.A. CASH