HomeMy Public PortalAbout9161 WOOLLEY ST_Sewer__ 7D
&E-6G3 11-34 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 D. GRIFFIN, SUPT OF BUILDING LOCALITY r
FOR APPLICANT TO FILL INNEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER y17
BLOCK TRACT = L � MAIL
ADDRESS
NO. OF BLDGS.
SIZE OF LOT !! ,� `( NOW ON LOT
_ CITY s ; TEL.
USE OF
B JILDIhGS t .,�..t DISTRICT NO. GROUP MAP
IG
CONTRAC'T`OR
ADGRr_S5 CONNECTION DATA
CITY —' -- / TEL. NO. .,,/ `'. sjJ� STATION _$ - DEPTH _
❑ STATE A7, MANHOLE REFERENCE
REGISTRATION N0. ii /'- E7 COUNTY A.> �, UPPER LOWER
// -..
- - TYPE OF CONNECTkON _* LENGTH-+R" -No. DESCRIPTION OF WORK FEE Y• CURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TQ
#� ! PUBLIC SEWER_ (ail $ 3.50 ----------
�I HOUSE SEWER CONNECTING TO
rI NATE_Di SPOSAL SYSTEM _ LaO.I y,r---•--- --•---
^ CONNECT ADDITIONAL BLDG, OR CO. INP. NO. JOB. N.O.
WORK TO HOUSE SEWER 1.00 ----�— ---- --
ALTER OR REPAIR EXISTING
_SEWTR OR DISPOSAL SYSTEM_ 1.00 j TRUNK PERMIT NO, ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER i STATE ENCROACHMENT !j
NU OR_ DISPOSAL SYSTEM 3 DO �__ PERMIT NO. _!
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DR AINFIELD 2.00 - _ INDUSTRIAL
CESSPOOL-D.RYWELL - J--
WASTE APPROVAL
SPECIAL__CONDITIONS ONLY 2 00 —
_ CHARGES
- t CONNECTION CHARGE;=EE
C) +tER'S RMIT
EPRNIIi ^� $
-- -
AUTHORIZATION TOTAL FEE f REIMB C[RSF:ir1ENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE � INSPECTOR'S SIGNATLRE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS i .DAY.OF 'y4 _19_x_ - .--
f` CONNECT ADDITIONAL
OWNER 0I2 BUILDINGOR WORK
OWNU,S A4TNT_.._,�._.._._o_ --
SEPTIC TANK, SEEP, PIT(S)
ADDRESS - _�f _AND/OR DRA1NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL[I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEINER OR
PLUMBING AND SE%VERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY RECISTERED AND/OR —'"- -'--_
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. _ BACKFILL SEPTIC TANKS 0
rl � SEEP.PiT(s) Ci CESSPOOLS 9
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
BY mal BY
DEPUTY DEP:ITY
p
8Y BY
DEPUTY ...rf / d r ''� ' '� ;✓ DEPUTY