HomeMy Public PortalAbout9085 WOOLLEY ST_Sewer__ 76AB42.0E-661 12-54 APPLICATION - FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Department 'o County Engilaees
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDREss �-
CASSATT D. GRIFFIN,SUPT at" SUILDING LOCALITY
am
FOR APPLICANT TO FILL IN . NEAREST
._._._. - CROSS ST.
LEGAL -
DESCRIPTION L_CIT NO. _. OWNER
BLOCK TRACT -- - MAIL _
ADDRESS
NO. OF BLDGS.
S17E OF LOT NOW ON LOT �CtTY TEL. N0.
USE OF —
BiSii. .
-INGS DISTRICT NO. GROUP NEAP
---� _ BK PG
J 4
CONTRACTOR
ADDRESS ! _ CONNEC;TION DATA
CITY'
.L yTEL. NO �' 4t -- ( _STATION p 3 C, DEPTH'
Q,STATE u MANACLE E REFERENCE, r
REGISTRATION N0. '=J// d CJ COUNTY _ UPPER / SLOWER
t i'. -4-
_.– TYPE OF CONNECTION- LJNGTH FP.OM f
NO. E�l CRIPTION OF WORK FEE _� CURB P L. +±.L TO P.L.
't
HOUSE SEWER CONNECTING TO
.Y_ 1 PUBLIC SEWER_
HOUSE SEWER CONNECTING tO
PRIVATE DISPOSAL SYSTEM ...�-.--.--
CONNECT ADDITIONAL BLDG., OR l i CO. INP.NO. +. t� JOB. NO.
Wf ORS TO HOUSE SEWER_
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM _ 1.00 j TRUNK FERN T N0. ROAD PERMIT NO,
D SCONNLCI AND ABAND( SEWER -._.
DISPOSAL STATE ENCROACHMENT OACH�%ENTAND/OR SYSTEM 1.00
SEPTIC TANK,SEEPAGE PIT OR ERM IT NO.
PITS AND/012 DRAINFIELD 4.00 ;NDUSTRIAL
_� CESSPOOL DRYV ELL -' -' -I� WASTE, APPROVAL -
_ ISPECIAL CONDITIONS ONLY F�- 2.00 f � .CHARGE:S•.
CONNECTION CHARGE FEE
AUTHORIZATION -TOTAL FEE
+ { �:ElMRURSEhIENT FEE
I- HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS O:ATf: {tvSPECTGI;`S 5IGNR7URE
TRACTOR TO C014NECT THE ABOVE DESCRIBED EXISTING DWELLING _
TO THE PUBLIC gyp'`ER,, - -
SIGNED THIS AY OF � >NEW HOUSE SEWER
19_ —
p � .'S, CONNECT ADDITIONAL
OWNER OR ,,fi�tt'� BUILDING OR WORK _
OWNERS AGENT_ +r---->,�v- ''� •3'"• ----'--' .-------
ACDREgS_._°...�� 'SEPTIC TANK, SEEP,PIT(S)
AND/OR DRAiNF1ELB _ _ _....._.—
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[] DRYWELL O
AND STATE: THAT THE ABOVE IS 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND +` ^
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DIS CONN HOUSE SEWER _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _..�._. _
DESCRIBED RESIDENTIAL PROPERTY. `BACKFILL SEPTIC TANKS 0 p}
SEEP,PIT($) Q CESSPOOLS t1
SIGNATURE a� - - -----
OF PERMiTTEE_�f=_ -
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY.
BY BY
() CL.?1,7 DEPUTY
YDEPAli:ThRir NT OF COUNTY ENGINEER ." SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY 1 PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ; BUILDING
I ADDRESS
FOR APPLICANT TO- FILL IN _ j' LOCALITY -
BUILDING �- Jr NEAREST
ADDRESS i y�-h .��i L_ i CROSS ST.
LOCALITY --� / DISTRICT NO. SERIAL NO. �jPERMIT NO, c
NEAREST _ `�
CROSS ST. REG VED BY Ready for Inspection DATE ISSUED
OWNER
MAIL ±
ADDRESS USE ZONE OCCUPANCY• BK MAP PG
CITY `" TEL.NO, 8—
CONTRACTOR. ,
V l / ,
^/rt l`( .yl.!.t.•S•el�. i 00.IMP.NO. '
ADDRESS ) �� L•1 JOB NO.
pi
CITY ,.Y. Ffjt .TEL.NO r� .Y /�� TRUNK PERMIT N0.
/ STATE i
REGISTRATION>NO. � ® COUNTY; ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT ! WASTE APPROVAL
SIZE
PROVAL-
SIZE OF LOT NO.OF BLDGS.-
NOW ON LOT a CHARGES
USE OF
BUILDINGS 'CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE { REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED_
_'WORK TO HOUSE SEWER
1.00
ALTER N0.OR REPAIR EXISTING I DATE I BY
SEWER OR DISPOSAL SYSTEM. 1.00
'DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 L 449., MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH,FROM
OWNERS PERMIT ; 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE ', o e)
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO-CONNECT THE ABOVE DESCRIBED -EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..--.-..—..DAY-OF...... _..19.___. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...:......._.....—..._—.—..._.—._...-._..____. BUILDING OR WORK
SEPTIC
ADDRESS..............._..._._..._.—,..,._.._.._._..._.:_. AND/OR DRAINFIELD IT(S) '
I HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLI- CESSP00•L�DRYWELL. + ,
CATION ANR STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH.ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR.
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY .THAT'I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM.THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
X SEEP.PIT(S)[:] CESSPOOLS[] f
SIONATIJ
OF PERMITTEE.._' —..1/...�...__. i 1-•-•�r t t-—A. :
701042A 668 7/58 �, �,