HomeMy Public PortalAbout9127 WOOLLEY ST_Sewer__ 5&E ' APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Das Angeles BUILDING ,.. ,
WM.J. FOX. COUNTY ENGINEER ADDRESS
S.:
CA.56,4TT D. GRI-1r.P'1N, suv°ran 8ua[..olrtc
FOR APPLICANT TO FILL IN —NEAREST
LEGAL.
I
_ssgRIPTION LOT NO. _ _OWNER e, 3 - --,
---- v _ e_
BLOCK TRACT ,� p MAIL �.
>. .ADDRESS
N0. OF BL DGS.
W - - -
OF LOT Lr '' NOON LOT _ CITY TEL. NO,
USE OF i' -
EUILD DISTRICT NO, I GROUP ! EK. MAP PG
AVDRESsw �1r r_n ,� ;;V- A,{y.,-, CONNECTION DATA
CITY ` TEL. N n •.y, - SL"T1dN - DEPTH
Q STATE - MANHOLE REFERENCE - - --�
REGISTRATION NO, y n `,'} k 's n COUNTY - 4 '•;Pp�'a... _ Ld`:!ER _
`"'"'L :TYPE OF CONNECTION LENGTH FROM
N0. D-ESCRIPTION UI• VVORK FEE YY� i EIRE P.L. ---?A.L_TO P.L. —
p
OU SE SEWER CONNECTING TO
5 PUP!iC SEWER _ C. $ 3_SQ
HOUSE SEWER.CONNECTING TO
PRIVATE DISPOSAL SYSTEM -
�� CONNEC ADDIriONP.`L ELDG. OR -----� �— —Cd IMP.N0. JOB. NO. _-
VIOR__K TO HOUSE S£kER 1.00 i
ALTER ORB PAIRE'(,S S ---'. --�� - UNK PERMIT N0. ROAD PERMIT NO,
I SEWER OR DISPO53A SYSTEM 1.00 i "B _
�! D S ONNECT AND A ANDON SEWER _ ;"fATE ENCROACHMENT
AM17;4R_DOSPOSAL-tS,EAi _7 0PERMIT NO.
SE'llyiC TANK( SiiFPACF. PIT OR -
___ P i$ ,ND/UIDAINFIFLD 2.00 ?^IDUSTRLAL
V C 5 OOLD,(Y4i ELL —� � -} { WASTE APPROVAL
SPcCI sL
CONDITIONS ONLY s 00 � I CHARGES
---'— CONNECTION CHARGE FEE
OWN 'S PERMIT t ! 00� --- -- --- — ----
AUTHORIZATION
TOTAL SEE , �� ��"-�� E El R E1nE?�r FEE
I HAVE' THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TP,ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS .. DATE INSPECTORS SIGNATURE
TO THE PUBLIC S"PMER - .,.., -- — .
NEW HOUSE SEINER
SsGNf D'rl(iSe DAY OF
OWNEROR " CONNECT ADDITIONAL
OWNERS AGENT. - - _�`-�.ae'�'.a•.°x.�* r..�-r _B(11LC1NG OR Y_OR'„`—� —
SEPTIC TANK. SEEP, PiT(S)
__AND/OR DR,AiNF�IELD
I .HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[j DRYWELL[3AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY ----.__.--
WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT I Aho PROPERLY REGISTERED AND/Ofi -”-`-- --'—_-� --
LiCENS.D AS RFQU.IRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND —�
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON};O L SEWER
DESCRIBED RESIDENTIAL PROPERTY, r� BACKFILL SEPTIC TANKS El
SEEP.P1T(S) ❑ CESSPOOLS Q
SIGNATURE ? __._
OF PERMITTEE u -4
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION
EY BY
DEPUTY DEPUTY
BY BY
(g) GFPUTY ^EPIITY