HomeMy Public PortalAbout9111 WOOLLEY ST_Sewer__ 76A642 D ��Mq pg��q ■■■^_gp� [�f�)�w��y FOR
PERMIT��{�w�
5d F-66312.54 A ! LI-CATION i V i L�RMIT 1
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN,SUPT OF BUILDING
wLOCALITY
FOR APPLICANT TO FILL IN NEAREST �
CROSS ST.
LEGAL
_D_SCRIP'CION_.LOT NO '� _ —OWNER
BLOCK TRACT MA€t.
ADDRESS
r� �f NO OF I�,LDGS., 'k
512E OF LOT NOW ON LOT / `CITY
TEL. NO.
USE OF
DISTRICT NO. GROUP I TRAP -
i 8K PG
ADDRESS COPTNECTION DATA
CITY TEL.N4y 'E11'" STATION DEPTH
L7 STATE MANHOLE REFERENCE
REGISTRATION .`,NO *3� -
;�� �` 1; ❑ COUNTY _ _ Ur^w s LOW;'ER
TYPE OF CONNECTION LENGTH FROM -NO. I DESCRIPTION OF 1h10RK FEE �. CU22 - P.L. uM..L.TO P.L.
1! H USE SFIVER Cb-NNECTIN3 TO v` -•. j _v� _
PUBLiCSEVE,. __ T_a $ 3`50
HOUSE SEW l:R CONNECTING TO� —
PRIVATE DISPOSAL SYSTEM __ 1.00
f I CONNECT ADDITI04A BLDG_. OR � CO. IMP. NO. JOB. NO.
e' t4GRK TO HOUSESEWER _ _1.00 �—� 1 �_• ---.� ---
I ALTER OR REPAIR.EXISYIING - ! PER,d IT N0. ROAD PERMIT NO.
SEWER OR FfSPOSAL SYSTEM 1.00 t "RU`NK 3 P
!i Di,C'ON ENCROACHMENTE T AND ABANDON SEWER � -I-- -
--- STATE ENCROACHMENTANt,-OR DIS AL SYSTEM1-00 ! PERMIT N0.
S 'TiC TANK,SEEPAGE PIT OR --- ---1— --- --.- _—.
_ Pi AND/OR DRA NFIELD 2.00 INDUSTRIAL
CESSPOOL DRYW •L — 1
-�--- WASTE APPROVAL
-
SPCiAL COND!TIUtu S.ONLY _2.00_ CHARGES
Q ' PEUUT-. -$-'� CONNECTION CHARGE FEE
15,IITHOMZATION TOTAL FEE ;. REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON. s_: DATE TOft'S SIGNf TI;>RE
APPROVALS
qg -
TRACTOR TO CONNECT THE ABOVE: DESCRIBED EXISTING DWELLING ai°�Od.�La�9 [NSPEC
TO THE PUBLIC S EER - �--- -- —'
NEW HOUSE SEWER
SIGNED THIS_. ,�' GAY OF
OWNER OR CONNECT ADDITIONAL
owNErs ADENT..._., �, ,,,�*�,; BUILDING K
p >i t _ -� _ OR WORK
SEPTIC TANK, SEEP, PIT(S)
-_ADDRESS_..._.—._. AN:D/OR DRAINrIE_t_0 _ -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ~CESSPOOLLJ DRY"WELL❑
Al10 STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO3\.`P LY
WITH ALL COUNTY ORDINANCES :AND STATE. LAWS REGULATING ALTER, REPAIR,S'E'WER OR
PLUMBING AND SEWERS. S_E_W_A_GE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT T AM PROPERLY REGISTERED ANIS/OR DISCONNECT PLUG AND
�_-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCO N HO USE,SEFYD
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPEn Y.
F t� BACKFILL SEPTIC TANKS❑ Y
SEEP. PITS)�. CESSPOOLS ' I
SIGNATURE r '. s _.OF PERM •` V .�'. i�' - PI ;Y i'"i
WILLIAM J.Fox.COUNTY ENGINEER VAIMATION
BY BY
DEPmTY DEPUTY
BY BY
& DEPUTY DEPUTY