HomeMy Public PortalAbout9136 WOOLLEY ST_Sewer__ SA 663 51.5?ti
° APPLICATION FOR PERMIT 1
S&H•G
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Loa Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER -
J CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY -
_.NEAREST
FOR APPLICANT TO FILL IN CROSS ST. /f. _
LEGAL _.
DESCRIPTION LOT NO _ OWNER
MAIL
BLC-CK_-.._ 7"R.AC �/'
-- :.j ..�NO. OF BLD .. r ap - CITY 1 '¢� TEL. NO.
_SUE OF LOT
USE OF f - -
BUILDINGS,_- � _ '' LL_� � `- DISTRICT NO. GROUP j MAP
BK PG
CONTRACTOR
n +� CONNECTION DATA
ADDRESS` _'
CITY _.. dY r ----TEL. NO. �64 -.- STATION c. e "`� �:3 DEPTH
-- J - MANHOLE REFERENCE .,r �, r. ,#.�. UPPER
STATE - e E.d a� �1=`-�7-. LO)M
REGISTRATION NO. �,di _Q COUNTY
NO. 1 DESCRIPTION OF WORK FEE; - -- -- - -- -- -
HOUSE SEINER CONNECTING TO �TYPE OF CONNECTIO LENGTH FROM
x Y. CURB P L ' M.L. TO P,L.
PUr3LIC-SEWER-- -�-$9.50 ` O -- - � --------..: _
-'fit ,---
SEPTIC TANK E-PACL PIT OR
_ { PITS AND/OR DRA_INFIELL of $.3 — -- ------- ---.----
_ _ _p0
OVERFLOW SEEPAGE PIT.GRAINFIELDf P_ C. NO
u >
j FXTN,.,CESSPOOL,DRYWELL,MANHOLE $2.00 ------
+ HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL SYSTEM (a. $i.O TRUNK PERMIT NO. ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.OR - --
' STATE ENCROACHMENT
-.---� WORK TO HOUSc.SEWER /tt: $.1.00 �. _ _- _PERMIT NO. --J_.---. _----`
ALTER,REPAIR OR ABANDON HOUSE I --- 1NDUSTR"AL-- -�- --- v ----
SEWER GR DISPOSAL SYSTEM WASTE APPROVAL
CHARGES
-__--.......;.___-. _. ._ CONNECTION CHARGE FEE
OWNER'S PERMIT 1 Oo --------------— --—-- —-- — _. ----
_...------------ ---- - REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE i _
I HAVE AT 'THIS DATE A CONTRACT 17H THEPPROVALS DATE hNSPECTOR SSIGf 4TI-:L HEREIN NAMED COCON- _..___ .-.IEEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER,_' _f 9.... FEW HOUSE SEWER
SIGNED THUS _DAY OF �_19 CONNECT ADDITIONAL
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OWNER OR PUILDING OR W-
.- � r°a - s'- f -.-_-.. -� ---- ---- - - -- --
OWNERS AGE SEPTIC TANK.SEEP, PAT(5) - -.
AA AND/CR DRAtNFI ,LD
ADDRESS--#A : .� --- --- ------ - --� _.-.._.--------- _.-_---.-.._-----._-._.
I HERESY ACKNOWLEDGE
THAT € H - READ THIS APPLICATION -- '— -�
CESSPOOL,;_-] DRYWEL.L
AND MATE. THAT 'THE ABOVE IS CO cT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES .AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE',DISPOSAL SYSTEM
?
HEREBY CERTIFY THAT 1 AM -PROPERLY REGISTERED AND,%OR DISCONNECT PLUG AND '
LICENSED AS REQUIRED BY LOS AN OUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT i AM THE LEGAI0WNER OF THE ABOVE -- -- � ------
DESCRIBED.RESIDENTI PROPERTY,, - BACKFILL SEPTIC TANKS
-SIGNATURE
SEEP-PIT(S) L EDCESSPOOLS 1
_
OF PERMITTEE - - - -I-
JOHN A. L.AMBIE. CO{d `! ENGINEER ALIDATIO ROBERT A.WOOD, CHIEF PLBG. INSPECTOR