HomeMy Public PortalAbout9130 WOOLLEY ST_Sewer__ APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT 0. GRIFFIN.SUPT OF BUILDING LOCALITY
FOR APPLICANT TO NEA:EST
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LEGAL --.�..�.
DESCRIPTION LOT NO r � _ °iitER -
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BLOCK TRACT MAIL -
F''1 _ - _ADDRESS
51:ZEFOT NO, OF BLU 5
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BUILDINGS _ 'r`>r - DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR -
ADDRESs CONNECTION DATA
CIT: T FL. NO ST,_- ..
�."TION '''' ,>� `% D PTH I'
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STATE MANHOLE REFERENCE r
REGISTRATION NO. ❑ COUNTY -_ _ ,.rsc f f - "',�LONER_
TYPE OF CONNECTI0 I^^-^ LENGTH FROM
NO, R DESCRIPTION OF WORK FEE Y. CURB P.L.+ M.L.TO P L. __--
HOUSE SEWER CONNECTING TO
PJB IC SEWER _ _r.$ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 I ---- -CONNECT ADDITIONAL BLDG. OR l � Co. IMP, N0. � ,� �,'^r' .JOB. No.. 9
WOPK TO HOUSE SE LR 1-00 I —.
AIT 0 R kG- R X 51!NG _
SEWER OR DISPOSAL SYSTEM 1.00_ _�— �n TRUINY PtFRR`IT NO ROAD PERMIT NC ,r
D CONNECT AND ABANDON SEINER
ANJ Oft_ C15PO AA SYSTEM Y.00 .--- z;T•AT ENCROACHMENT
S T C tiNK _F A - FIT OR
I� FRMVT NO_
NTS AND/ DRAt t eLD 00 !�_ DUSTRlAL. B
_....--- _. ._ -__ ----I -- Y ASIE APPROVAL
SFECI:AL CCN IIT1O0 . ONLY � 00 I i CHARGESV_
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- F�EFtP�,T — --- ,-'-- _cGNNEcT+GN CHARGE FEE
®VJNF.I?'s _ T _ 11 00
AUTHORIZATION 1 Tt3TAL FEE y: EIn;BURSEa1 NT SEI-
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAM{ D � A2"Cdi6/T�ALe7 DATE �IPS_PrCTOFt'S SIGNATURE
CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED E=XISTING DWEILOIG, _ 77....��
TO THE PUB IC Et•G R
y NEW HOUSE SEWER
SIGNED THIS DAY GF� �19 _.
=4'NFR C•R __a__-_----
r CONNECT ADDITIONAL
0 j.a t," (e �`..�' __ BUILDING OR VdGRK _
OWNERS AGEN?_`1,1- ..e= 3�.� - .- q _ ---__—..._. __. _.__--
r ?•/ 1 .-.g SEPTIC TANK, SEEP, PIT(5)
AND/OR D_RAI_NFI_c.LD _..__..._�..._...... -
A40HERyBY ACKNOWLEDGE THAT I HAVE RiAD THIS APPLICATION CESSPOOL E7 DRYW£LL❑ s`
ANC 5'1"ATE THAT THE ABOVE IS CORRECT AND AGREE. TO COMPL`i -._......_.....—._�__.�.�,-..�_—
WlTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR,SEINER OR
PLUMBINC, AND SEWERS.
SE11'AGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REG'SIERED AND/'OR —"--" '---� —
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OT DISCONNECT PLUG AND �
CAL FORNIA OR THAT. 1 AM THE LEGAL OWNER OF THE ABOVE _ABANDON NOU5E SEWER
DESCRIBED RESIDENTIAL PROPERTY. a BACKFILL SEPTIC TANKS 0 I
- ;! SEEP PITS) G_CESSPOOLS rr1_ _..._...<..._.__-
SIGNATURE f7l',
OF PERIAITTEEVOL
WILLIAM J. FOX. COUNTY ENCE,INEER VALWAT'ION
SY BY
DEPUTY DEPUTY -
BY E,e
L`-J DEPU"T't' DEPUTY