HomeMy Public PortalAbout9069 WOOLLEY ST_Sewer__ 7CA0420
E-663 3.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILVING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. T'A Ik A
LEGAL
DESCRIPTION LOT NO, OWNER
PAIL
A.-0 D-RI-ES.
NO. OF BLDGS.
NOW ON LOT TEL.NO.
USE OF CITY T-1 -
UfLDINGS DISTRICT NO. GROUP MA
B K.
CONTRACTOR
ADDRESS CONNECTION DATA
T�' R� TEL. .14 0.A STATION DEPTH
( —
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO.
5"OUNTY
NO, j DESCRIPTION OF WORK FEE
TYPE OF C0NNICT1r,7; LENGTH FROM
HOUSE SCWEi CONNECTING TO- 3
O
PUGLfC SEWER (q) $ 3.50 CURB M.L.
TO P.L.
HO.USE SEW CR CONNECTING TO
PRIVATE D1,5POSAL SYSTEM 1.00
I CON114ECT ADDITIONAL BLDG. OR P. C. N0.
TO HOUSE SEWER 1.0_0 CO. IMP. NO. JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERM(T NO� ROAD PEPMtT MO,
DISCON'4ECT AND ABANDON SEWER STATE ENCROACHMENT
AND/ORD IS POST,L SYSTEM 1 10 PERMIT NO,
SEPTIC TANK, SEEPAGE PIT OR
OR DRAINFIELD 2.00, INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00
CHARGES
CONNECTION CHARGE FEE
OWNER'S PEAT 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS PATE CONTRACTED W11H THE HEREIN NAMED EON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DINELLIN"G APPROVALS DATE INSPECTORS-SIGNATURE
SIGNATURE
To THE PUBLIC SEWER
SIGNED THIS--DAY OF NEW HOUSE SEWER
CONNECT ADDITW
BUILDING OR)NORK
OWNER OR L
OWNERS AI.FNT- ......- —
SEPTIC TANK,SEEP, PIT(5)
AND/OR D--mc4FHELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CFSSPOOLL-j DRYWELLD
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE To COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAER OR
IR.SE
SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
__ABA!NDOI
ABANDON W
SEER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS C
SEEP. PIT(S) CESSPOOLS❑
Y,
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION Ro A,WOOD. CHIEF PLBG. INSPECTOR
J z"
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