HomeMy Public PortalAbout9002 WOOLLEY ST_Sewer__ APPLICATION FOR PERMIT-
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL'
Department of County Engineer
County of Los Angeles BUILDING
`M.J. FOX.COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF SUtILDI1NC LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROS ST_ In
LEGAL
DESCRIPTION LOT N2- 0%VNER
BLOC\ TRACT � .�� fy��-� MAIL
Ai y _ f.r.r �•
._._ _..._._. .._.. �.. DDRESS
NO. OF BLDGS,
S32t OF LOTf NOeV 0'd LOTf CtTY� a o-" 1 Z TEL. NO
USE OF
BUILDINGS ; D f - -
�iSTz21CT 1V9 GROUP Y,AP
SIS: PG
CONTRACTOR -, --. -
ADDRESS _ • i4-�- ✓� :�'.`. C£7NNECTION DATA
CITY_._.__ TEL NO '.. �'• STATION ,f',I--- ..�— DE?7N
y STATC MANHOLE RIFE.RZ-N Cc-
UPPER
REGISTRATION NO. rCOUNTY ------__..,_E_ _ _.._ .`_'`t:=.�y -
NO-1 DESCRIPTION OF WORK FEE �__--,-____._.--------__— -__------- —_-.-_._----
.. TYPE 6F G�JNNECT - LENGT
-----` I'!
FRO AS
ttOJ:E SEWER CONNECTING TO �.. ( O_�",„,,.
Pt BLIC SEWER !,� �. 3 S�I � �`v'Fa..s .�. CLRB '._'P_L N L. TOP L.
HOUSE
SEWER CONNECTING TO
PRIVATE N POSAL SYSTEM_
C NNECt ADDITIONAL BLDG. OR fC' >� Y P C. NO
WoRr r0 HOUSE SEW ER t.OG _ CC. iM? 1'.J. r ...� -•' ]OB NO.
111:P_OR REPAIR EXISTING. —
t SEW'LR OR D:S OSAL SYST'CM 1.00 j -- TRUNK PERM;1T NO. RO.;kD PERMIT NO.
I DI
I
ARD/Op,NDfS ✓tSA'ASYST.EEhM1,00 STATE ENCROACHMENT
PERMIT NO.
� SL- 1C-R,% PIT OR
_! PATSAND/Oh DRAINFIPLD �,2_�)l___ Wt,;�i.. :11 FAL APPROVAL
CESSPOOLLRY'WEII. I –m–�..–
–SI LIAL_C. N O ^:TIONNLY E Cn
_-C—. S O ._.__.._ ---. CHARGES r
CON'NEC 1ON CHARGE FEL
Ar TT OBI A`IIO TOTAL FEE ^ I I --- REIN-RURSESIENT REE -
- — -
I }"pVE' T'85 D4 'v- CONTRACTED WITH THE HERE1rV NAI•Iri) CON. y��T ye C�
T.a'i:.CTOR 0 COY'hECT THE ABOVE DESCRiSED EXISTING D.AELL.ING APPROVALS D3,Tt �liti S P ECTOR'S S I Gs N AT URE
TO i cPUBLIC S..vE-i
– NEW HOUSE SEWER
5iGId,D THIS— .-,,� .__.._DAY QF 9 a
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT— :,.y �Yr u–t-,�.f '�UiLDiNG OR WORK
– --– – -- _ .---
�_ r SEPTIC TANX,SEEP,PIT(S)
4DD�tr 5. L -- � _T--�..• .-- AVD/OR DRAINFIELD
I
HEREBY ACKNOWLEDGE THAT I t-EAVE READ THIS APPLICATION; CESS OOL[] DRYWELL CJ
AND STATE THA2 SHE ABOVE IS COTIP;CT AND AGREE TO C YPIY
WITH ALL COUNTY ORDSNANCES AND STATE LAWS REGULAl`S kt+1. ALTER,REPAIR S"WEE?OR
PLUMBING AND SEWERS. SEWAGE DiSPO Al.SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/CR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ 4BA_NC70N SiO_USt r.luE_R y _
DESCIRMED RESIDENTIAL i'RCrP€,ATY, –SACKFIL.L SEPTIC TANKS C
SEEP P (S Q! CESSPOOLS I_? !!!
SIGNATURE 7 –
CF PERMITTEE – e E1E1
WILLIAM J.FOX.COUNTY ENGINEER VA MATION Ft.A.WOOD, CHIEF FLBG. INSPECTOR
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