HomeMy Public PortalAbout9079 WOOLLEY ST_Sewer__ 76A6420APPLICATION FOR PERMIT 1
E-86
2&E-663 3.56
DIVISION OF BUILDING AND SAFETY" SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angoles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF 6UILOXNG LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL —
DESCRIPTION LOT NO, ,yg .�� �'��` ,y'': <1_: OWNER
BLOCK TRACT MAIL -
...-_r.---�--_......_.
NO, OF SLOGS,
SIZE OF LOT i _ _NOWON LOT CITY
TEL, NO. -
USE OF e - — -
IIUILDI1 4GS DISTRICT 14 0. I GROUP MAP
EK PG
CONTRACTOR
ADDREs_. CONNECTION DATA
CIT, t L, NO STATION P< ,v"' C " DEPTH '':.,3✓1^°
�_�—.,r_��__-_--. ❑ STATE MANHOLE REFERENCE
REGISTRATION NO, COUNTY .-- —_"------- .-- ��� .� LOWER_
N0.{` DESCRIPTION OF WORK FEE -- - —
�— -- - tP OF CONNECTION-- LENGTH FROM -.
HOUSE SEWER CONNECTING TO °' fie. Y•_.__..__._CURB P L'l M L, TO P.L.
SEWER __ $_3.50
_.- _..
!� H -SSE SEsh E4 CONNECTING TO'V -- — -- -- --.__�A._ —'-�. ------�-- -.
PR14_ATE I.ISPOSAL S STEM -1.0_0 _
CONNECT ADDITJOhAL BLDG. OR �.., y P C NO.
h}CRK TO HOSE SEWER 1.00 _ _CO. IMP. NO. . .—j JOB NO.
ALTER OR REPAIR EXISTING --
SEWER OR DISPOSAL SYSTEM 1.00.� 1 TRUNK PERMIT NO, ROAD PERMIT NO,
'r DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT ~�
AND/OR DISPOSAL SYS EM 1,00 1PERMIT -
,___-- - -- ----- _ NO,
SFPnC ANKI SEEPAGE PIT OR -- -- ---�-"'—
P175 AND 0R CRAIPoFiz_LD 2.00
INDUSTRIAL
��CESSPOOL DROVELL _WASTE APPROVAL °4
S.PECIAL CONDITIONS ONLY 2.0_0 CHARGES.
OWNER'S PERI IT S 1 00 ON_�CTIOPI CHARGE FEE -— —
AUTHORIZATION 'TOTAL FIE � � REIMBURSEMENT FEF
I HALE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- �y :t��+
TRACTOR TO CONN ECT T=IE ABOVE DESCRI3ED EXISTING DWELLING APPROVALS _ I DATE INSP'CTOR'S SIGNATURE
TO THE PUBLIC SEWER — '�---
NEIN HOUSE SEWER
GIGNED 'CHIS ' ._.DAY OF------.---.
OWNER OR CONNECT ADDITIONAL
OWNERS AGEINT,___. - BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
[AND
RESS—,._— __--W.__..�._ _-:_:.. —_ _- AND/OR DRAT PH MLD
14CREDY ACKNOWLEDGE THAT I-HAVE READ. THIS APPLICATION CESSPOOL[] DRYWELL i
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYH ALL COUNTY ORDINANCES AND STATE LAWS REGULAiiNG ALTER, REPAIR, SEWER OR
MBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I A.M PROPERLY REGISTERED AND;ORNSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG ANDFORNIA OR THAT' I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
RIBED RESIDENTIAL PR!:?ERTY. BACKFiLL.SEPTIC TANKSSEEP P1T(�} POO L$0ATURE
PERMITTEE
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLOG. INSPECTOR
5 a.f' DEC_ 7 4 4.5 0
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