HomeMy Public PortalAbout9076 WOOLLEY ST_Sewer__ rrIAr-66 APPLrcATror�r FOR PERMIT1
i&f»-063 11-55
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Depariment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAIMBIE, COUNTY ENO,INEER AD9REss
__ -----
7 CASSAT•T L), GRIFFIN, .SUP'r OF BUILDING LOCALITY
FOPLICANT TO F'ILL-IN CROSS s. --
LEGAL ✓ -- - -- - --
DESCRIPTION 1,01' NO.
k-- - OWNER -_ ----- -- - --- -
- --' MAIL
BLOCK TRACT ADDRESS
N 0,f BL,DGS. -
SIZE OF LOT NOW -IN LOT CITYTEL. NO,
USE OF DiSTRICi Tdt�. GROUP MAP
EUILDiNGS '�„
BK PG
CONTRACTOR <-� -
-- CONNECTION DATA � r.
ADDRESS
- ----- -- --
CIT'f T£L NO.
STATION
---- - -
- ---_ :..- ------- MANHOLE NCE
s
L. -AYE ------------ t.,..'- ,. ':
' L-_ -
REGISTRATION NO, -A--`J—COUNTY
NO i DtSCu1P,ION OF 4i`GFK -- FEE - YPE OF t'.(7NNECTION ----LENGTH FROM _
a I
HOUSE SEWER C01dNE.CYI._, 0 -- � Y. CURB P.L, M L. TO P.L.
`
.-PUB 1�C S E rM1 R - - -- - ---- @$3.E3 E —._.._---- --- —
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR I RAIN
ELD .00
rl y 3 �..-.----
i OVERFLOW SEEPAGE PIT,DRI'INFI 'LD ^� y P C. NO.
Ek iN ,CtaSPO`�L;DR ALi„M�Nu�L[ �cc $ CO.
HOiSE SEd ER ONNECTIN.G iO - — _-- —
PRIVATE DISPOSAL SYSf 11 ce $I.Dv CRUNK PERMIT NO, ROAD PERMIT NOS
G.OR �-- STATE ENCROACHMENT v
WORK 70 HOUSE SE'!.EP, _ ca, $t.0 ' PERMIT NO.
—i ALTER,RE2 IP OR ABa IDON HOUSE f INDUSTRIAL
_---�-
SEWER ORt SPOSxSYSTEM ---- $1.Oi
-- -._ __. ---- -- _--_ WASTE APPROVAL
--__...-- ---- ---------!_ —I CHARGES _
L
CONNECTION CHARGE FEE
OWNER'S PERMIT S I 1 UO
�$Is _iTIiOIiyATI03�iTOTAL FEE -- l _ _- REIMBURSEMENT FEE
,i 50
i NiPECTOR Ss:GN9TU'iE
i HAVE AT THIS DATE A CONTRACT WITH 'tr£ HEREIN NAMoD APPROVAL
GUN- ..__._-. -__-_-_-.--_._-.S ATE
TRACTOR TO CONNECT THE. ABOVE DESCR.I13ED ES[STiNG DWELLING
TO TEE FURLIC SE'WtR. NEW HOUSE SEWER
SIGNED THIS_✓".'_'-_DAYOF__�`" - ADDITIONAL-- - --
__ --
OF—
CONNECT
OWNER OR _
BUILDNC
OR `Ait 4iC
OWNERS AGENT ... .r -._ - L-- - - _----
SEP
TANK.STEP, PtTiSf
_ AND/OR DRAIN iELD
ADDRE S—_ '.__ = �-_e. , ,y-:.-r- ---_ _-_- _._.----- -----{--------..�-- -_-.--
I RFRFBY ACKNOWLEDGE THAT I HAVE READ TYIS APP.LICATiON CESSPOOLO DRYW'E:1_L O �
AND STATE. TNCf THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND 'STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING,, AND SCS ERS, SEWAyi DISPOSAL SYSTEM
I HERESY CERT -'fAT I AMPROPERLY REGISTERED ^ND;'OR DISCONNECT PLUGAND
L-tCENS-:D AS REO IRED BY LOS ANGELES COUNTY AND STATE OF ABANDON I I
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF-THE ABOVE HGUSEa rri�R �
DESCRt E.ED R._.. UENTiAL PROPERTY. FACKFIL1 SEPTIC TANKS[_j
SEEP. P1.(S) L, CESSPOOLS❑ '
SIGNATURE. - - _._."_. _. -
9F 'MiTTEF;
y
JOHN A. LAMBIE, I=NGINEFR VALIDATION ROBERT A. WOOD,CHIEF FLBG, INSPECTOR
CK"
6CK. M.Q. CA-H
s